Application - New - Community Christian Academy

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Business Office: 706.568.7357
Classroom: 706.221.7352

7909 Fortson Road | Columbus, GA

Application for Enrollment for New Student

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NOTICE

This application is for new students only, and is only the application for enrollment. The enrollment processing forms will be provided once your enrollment is accepted.

Parent Information for the Parent Completing the Application

Parent's Name

First

Last

Parent's Phone

Enter Mobile #

Parent's Email

Confirm Email

Enter Valid E-Mail Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Family Church Information

Do you & your family faithfully attend a church service?

Faithfully attend means you attend, in person, at least one service per week regularly.

Are You a Professing Christian?

Yes
No
Not Sure

Name & Address of Your Church

Provide your church's name & address.

Pastor's Name

Children Names

Child's Name

First

Last

Date of Birth

Select your child's birthdate

Gender

Male / Boy
Female / Girl

Last Grade Completed

Select the LAST grade your child completed

Parental Commitment Agreement:

I understand that enrollment in CCA is contingent upon the following two commitments:

1. Faithful attendance in a Bible-believing church, and seeking to follow biblical teaching.

2. A commitment to being fully engaged in my child's education, and following the required guidelines for the teacher-assisted accelerated program.

I agree:

Signature & Affirmation

Clear Signature

Application Fee

Price: $45.00

Please note that the Application Fee is non-refundable

Total

Item Quantity Qty Total

There are no products selected.

Application Fee 1 $45.00

Subtotal

Total $45.00

Date Family Children

Credit or Debit Card

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