Student Enrollment Application

Student's Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

First Guardian's Name *

First Name

Last Name

First Guardian's Phone *

(###)

###

####

Second Guardian's Name

If applicable

First Name

Last Name

Second Guardian's Phone

(###)

###

####

Student's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous School's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Has the Student ever repeated a grade, been disciplined, suspended, or expelled by an academic institution? *

Yes

No

Does the Student have and Diagnosed Medical Conditions? *

Yes

No

Will the Student need Medications on Campus? *

Yes

No

I authorize the staff of Lisbon Falls Christian Academy, in the case of a medical emergency, to administer first aid treatment and call emergency services in order to provide transport to a medical facility for emergency medical care for the enrolling Student. *

Yes

No

Has the Student reviewed LFCA's Student Handbook? *

The student handbook can be found here: https://www.lisbonfallschristianacademy.org/s/LFCA-Handbook-revised-2018.pdf

Yes

No

Will the Student agree to adhere to the LFCA Student Handbook? *

Yes

No

Does the Student Attend Church Regularly? *

Yes

No

If "Yes" above, please provide the Address of the Church the Student attends.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is the Student a Christian? *

Yes

No

Not sure