Membership New Family Application Father Name *FirstLastMother Name *FirstLastEmail *Phone Number *Zip Code *Christian? *Both ParentsFatherMotherHome Church *Parent Christian Testimony *Reference Name *FirstLastPastor or Church LeaderReference Email Address or Phone Number *Reference Name *FirstLastReference Email Address or Phone Number *Children Live With *Both ParentsMotherFatherOtherChild 1 *FirstLastChild 1 Date of Birth *Child 1 Gender *MaleFemaleChild 1 Grade *K123456789101112Child 1 Previous Schools *List previous schools and gradesChild 1 Previous Behavior Concerns *Describe any previous behavior issues where disciplinary action was required by school.Child 1 Learning Differences (e.g., Dyslexia, ADHD, etc.) *Child 1 Medical Issues/Other Special Needs *HCA cannot provide an allergen-free environment at lunch, administer medication or manage any health issues.Child 2FirstLastChild 2 Date of BirthChild 2 GenderMaleFemaleChild 2 GradeK123456789101112Child 2 Previous SchoolsList previous schools and gradesChild 2 Previous Behavior ConcernsDescribe any previous behavior issues where disciplinary action was required by school.Child 2 Learning Issues (e.g., Dyslexia, ADHD, etc.)Child 2 Medical Issues/Other Special NeedsHCA cannot provide an allergen-free environment at lunch, administer medication or manage any health issues.Child 3FirstLastChild 3 Date of BirthChild 3 GenderMaleFemaleChild 3 GradeK123456789101112Child 3 Previous SchoolsList previous schools and gradesChild 3 Previous Behavior ConcernsDescribe any previous behavior issues where disciplinary action was required by school.Child 3 Learning Issues (e.g., Dyslexia, ADHD, etc.)Child 3 Medical Issues/Other Special NeedsHCA cannot provide an allergen-free environment at lunch, administer medication or manage any health issues.Child 4FirstLastChild 4 Date of BirthChild 4 GenderMaleFemaleChild 4 GradeK123456789101112Child 4 Previous SchoolsList previous schools and gradesChild 4 Previous Behavior ConcernsDescribe any previous behavior issues where disciplinary action was required by school.Child 4 Learning Issues (e.g., Dyslexia, ADHD, etc.)Child 4 Medical Issues/Other Special NeedsHCA cannot provide an allergen-free environment at lunch, administer medication or manage any health issues.EmailSubmit Things To Know Registration for the 2019-2020 school year is currently open for returning and new families. PHONE 000-000-0000 EMAIL admin@homeschoolchristianacademy.org ADDRESS SAYSF Bible Church