Student Enrollment

Student Enrollment

Crossroads Christian School, Inc. oNew Student oAdditional Student PO Box 295, Crestview, FL 32536 oRe-Enrollment	Date
Student’s Legal Name Nickname	Grade
Date of Birth	Age
Place of Birth	Sex Race
Student’s Address	Phone Number Family Email Address
Father’s Name Driver's License #	Occupation
Place of Employment oFull-time oPart-time Work Phone Number	Title/Rank
Mother’s Name Driver's License #	Occupation
Place of Employment oFull-time oPart-time Work Phone Number	Title/Rank
Church Name	Pastor's Name
Church Address	Phone Number

A. Has your family ever had your homeschool program legally investigated or suspended? o Yes o No

B. Has student ever been expelled from a school? oYes oNo

C. Has student ever been arrested or detained? oYes oNo

D. Does student smoke, consume alcohol, use illegal drugs, or in a rehabilitation program? oYes oNo

If you answer yes to any of the above, please explain in more detail on the back or on a separate sheet of paper.

oI have read the Statement of Faith and am in agreement. oI have read the Statement of Faith and do not agree. Please explain.

oI have read and am in agreement with the Affirmation of Commitment

oI have read and accept the Crossroads Policy Statement.

Parent's Signature:

__________________________________________________________Date____________________