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Thank you for your interest in Community Christian Academy!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • How Did You Hear About Us? *
    Details:

  • Reason for school change?
    *

  • If other, please explain:
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Most Recent School Name:
    *

  • Most Recent School City:

  • Most Recent School State:

  • Most Recent School Phone Number:
    *

  • Does this child have a(n) IEP or 504?
    *

  • If so, please explain:

  • I understand that Community Christian Academy is unable to offer any special accommodations for an IEP or 504 Plan.
    * Yes   No

  • Has this child been suspended or expelled for any reason?
    * Yes   No

  • If so, please explain:

  • Has your student been cited for excessive absences or tardies?
    * Yes   No

  • Are there any special circumstances your student may require?
    * Yes   No

  • If so, please explain:

  • My student is interested in:
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •