Application Form

FCA student application form for 2024/2025 school year.

Student's Name*
First Middle Last
Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Birthplace*
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Email
Class*
Emergency Information
Emergency Contact Name
Emergency Phone
Prior School Information
School Last Attended
Name
School Address
Street Address Address Line 2 City State ZIP Code
Family Information
Father's Name Present Address Marital Status Church
Mother's Name Present Address Marital Status Church
Legal Guardian
Place of Employment of Father/Legal Guardian
Name Address Phone Number
Place of Employment of Mother/Legal Guardian
Name Address Phone Number
List other children living with the family
Name Date of Birth School Currently Attending
Other adults living in the home
Relationship to student
Number

Name	Date of Birth	School Currently Attending

Emergency Information