Registration

Heritage Christian School registration

Name*
First Last
Email*
Enter Email Confirm Email
Date*
MM slash DD slash YYYY
Student Information
Name of Student*
First Middle Last
Date of Birth*
Sex*
age*
Current Grade*
Has Student ever been enrolled in another school?
School Address
School Name Address City State / Province / Region ZIP / Postal Code
Family Information
Father's Name*
First Last
Father's Phone*
Father's Email*
Father's Occupation*
Father's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's Name*
First Last
Mother's Phone*
Mother's Email*
Mother's Occupation*
Mother's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parental Status*
Medical
Name of Physician
First Last Phone
Please list any medical issues that we should know about
Please list any medical issues that we should know about
Emergency Contact 1*
First Last Phone Relationship
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact 2*
First Last Phone Relationship
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Consent
I agree and give consent
I give consent for HCM to secure any and all necessary emergency medical care for my child
Consent
I agree
My child can take Tylenol or Ibuprofen
Documentation
Birth Certificate*
Max. file size: 2 GB.
Social Security Card
Max. file size: 2 GB.
Shot Record
Max. file size: 2 GB.
Photography and Social Media Consent
I agree to photographs and social media
From time to time we will be taking pictures of the students and posting on social media for the purpose of advertising. We also will be doing live chapel services where the student could be on Facebook or YouTube.
Church Information
Church Name
Church Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pastor's Name
Pastor Church Number
Signature*

Registration

Student Information

Family Information

Medical

Documentation

Church Information

Services

Contact