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 *

YesNo

I certify.

Yes, you have my consent.No, you do not have my consent.

Yes

Yes

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