EnrollmentPacket_2022_2023 Grace Christian Academy Application Form for New and Returning Students School Year 2022 – 2023 For Office Use Only RABA #_______ Grade Applying for _______ Student Information: Student Name: * Student Name: First First Middle Middle Last Last Goes By: Birthday * Date of birth in YYYY-MM-DD format. For example: 2003-10-12 Age: * Place of Birth: * Citizenship: * (Kindergarten 4 and 5 applicants must be 4 and 5 years old on or before August 31 of the current year regardless of any previous school attendance) Gender: * Male Female Hospital # (CHC): Grade Level Applying for: * K4K5123456789101112 Child # * Of * Mailing Address: PO BOX * City, State * Village: * Phone * Foreign Student: US Visa (F1/F2/E2/CW2) No: Expiration Date: Passport No: Expiration Date: Ethnic Background: * Chamorro Carolinian Micronesian American Japanese Filipino Korean Chinese Other Other Ethinic Name and Grades of any other children enrolled at GCA: Name and complete address of previous school: Primary Language: * Secondary Language: * Religious Affiliation: * Church Attending: For Kindegarten only – Is your child potty trained? yes no Frequency of Accidents: Parent/Guardian Personal and Employment Background: =================================================================================================== Father/Guardian Details: Title: Is child living with Father/Guardian? * yes no Father/Guardian Name: * Father/Guardian Name: First First Middle Middle Last Last Father/Guardian Ethnic Background: * Chamorro Carolinian Micronesian American Japanese Filipino Korean Chinese Other Other Ethinic Work Phone: Cell Phone: Email Address: Occupation: Employer: Employer Address City State Zipcode Village Father/Guardian Residential Status: Non-Resident Alien Resident Alien Local Resident US Resident Father/Guardian Authorization: Receive Bill Copy Responsible for Bill Receive Report Card Send Mail Authorize Pickup =================================================================================================== Mother/Guardian Details: Title: Is child living with Mother/Guardian? * yes no Mother/Guardian Name: * Mother/Guardian Name: First First Middle Middle Last Last Mother/Guardian Ethnic Background: * Chamorro Carolinian Micronesian American Japanese Filipino Korean Chinese Other Other Ethinic Work Phone: Cell Phone: Email Address: Occupation: Employer: Employer Address City State Zipcode Village Mother/Guardian Residential Status: Non-Resident Alien Resident Alien Local Resident US Resident Mother/Guardian Authorization: Receive Bill Copy Responsible for Bill Receive Report Card Send Mail Authorize Pickup =================================================================================================== Other Family Details: Other Family Member: Title: Relationship to Student: Is child living with? yes no Other Family Member Name: * Other Family Member Name: First First Middle Middle Last Last Ethnic Background: * Chamorro Carolinian Micronesian American Japanese Filipino Korean Chinese Other Other Ethinic Work Phone: Cell Phone: Email Address: Occupation: Employer: Employer Address City State Zipcode Village Residential Status: Non-Resident Alien Resident Alien Local Resident US Resident Authorization: Receive Bill Copy Responsible for Bill Receive Report Card Send Mail Authorize Pickup reCAPTCHA If you are human, leave this field blank. Submit Share this:Click to share on Facebook (Opens in new window)MoreClick to share on Pinterest (Opens in new window)Like this:Like Loading...
