Registration – WOACA- Wings of Angels Christian Academy

First Name *

Middle Name *

Last Name *

Child's Age *

Date of Birth *

What grade is your child in? *

What school does your child attend? *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Mother's Name/Guardian *

Email Address *

Phone *

Fathers Name/Guardian

Email Address

Phone

Emergency contact *

Email Address *

Phone *

Emergency contact

Phone

Email Address

Name of person who may pick up child (identification required) *

Relationship to child *

Name of person who may pick up child (identification required)

Relationship to child

Does your child have any special needs, medical conditions, medications or allergies? if yes, please explain *

EMERGENCY MEDICAL RELEASE: If emergency medical care is necessary and I cannot be reached, I authorize Wings of Angels Christian Academy to act in my behalf in granting permission for my child to receice emergency medical treatment. Parents are responsible for all expenses as the result of medical treatment. *YesNo

I certify that the above information is correct and true. *I certify.

Wings of Angels Christian Academy staff may be videotaping and taking photographs of the children during the program. This documentation may be used in future brochures or posters as well as our social media sights or Web pages. This documentation may be used in presensations for the program. We would like your permission to include your child in these photographs. *Yes, you have my consent.No, you do not have my consent.

I give wings of angels Christian academy permission to text or communicate by any other means to the numbers above. *Yes

I understand that I will pay the registration fee prior to services being rendered. I understand that balances will be paid monthly.Yes

Wings of Angels Christian Academy, Inc. is a non-profit 501(c)(3) organization.