2022-2023 Enrollment Application

Student Information

Student Name

Student Date of Birth

Grade in the Fall

New Student Returning Student

Enrollment Options

Half Day Full Day

Household Information

Father's Name

Father's Cell Phone

Mother's Name

Mother's Cell Phone

Primary Address

Parent's Email

This address will receive a confirmation email

Primary Contact Phone

Home Church

Father's Occupation and Employer

Mother's Occupation and Employer

Additional Student Information

Academic History

Academic Needs or Concerns

Most and Least Favorite Subjects

Medical Needs and Allergies

Behavior Needs or Concerns (please be specific)

Hobbies or Special Interests

Normal Sleep Schedule

TV and Computer Habits

Emergency Contact

Emergency Contact Phone Number

Do you have any questions?

Publicity Waiver

Publicity Waiver: I recognize that Streams of Hope Christian Academy uses photographs and video images of events on their school/church (Heartland Church) website and social media outlets. I hereby grant permission for photo/video images of my child to be taken and used for such purposes.

Photo and Video images may be used on the school/church websites and social media outlets.

I agree I DO NOT agree

Application Fee 75

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out the Streams of Hope application and pay the non-refundable application fee

2022-2023 Enrollment Application

Description

Please Fix the Following