Canon Christian Academy
Christ-Centered Education in Canon City, CO
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Admission Form
Applicant's Information
Applicant's Full Name (Student)
*
First
Last
Birth Date
*
Date Format: MM slash DD slash YYYY
Male / Female
*
Male
Female
Place Of Birth
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Years At Address
*
Email
*
Home Phone
*
Father's Information
Father's Name
*
First
Last
Father's Cell
Father's Occupation
Father's Place of Employment
Father's Education
High School
College
Is the father a Christian?
*
Yes
No
On what do you base your answer about being a Christian?
*
Mother's Information
Mother's Name
*
First
Last
Mother's Cell
Mother's Occupation
Mother's Place of Employment
Mother's Education
High School
College
Is the mother a Christian?
*
Yes
No
On what do you base your answer about being a Christian?
*
Applicant's School Information
Current Grade
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Last report card presented for grade
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Has applicant ever been dismissed from school for any reason?
Yes
No
Reason for school dismissal
*
Has applicant failed a grade?
*
Yes
No
Which grade did the applicant fail?
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Reason For Failure
*
Schools Attended
List all schools attended with most recent school first.
School
School Name
Address
Grade
Reason For Leaving
Why do you want your child to attend this school?
Do you expect your child to continue in this school after this grade?
*
Yes
No
Does the student have any mental, emotional, or physical handicap which may affect him/her in school activities or academic progress?
*
Yes
No
Handicap Explanation
*
Family Information
Other Children Living With Family
Child's Name
Child's Age
Do you regularly attend a church?
*
Yes
No
Church You Attend
*
Pastor's Name
*
First
Last
Pastor's Phone
*
Does applicant regularly attend a church?
*
Yes
No
Please read and prepare to discuss the following covenant:
CCA Covenant
“I support the standards of the school and will not tolerate profanity, obscenity in word or action, dishonor to God or the Word of God, or disrespect to the staff of the school. I hereby agree to support regulations published in the school handbook in the applicant’s behalf and authorize the school to employ discipline as it deems wise and expedient for the training of my child. As necessary, I further agree that we will cooperate and discipline our child in the home as needed.”
“I agree to uphold and support the high academic standards of the school by encouraging my child in the completion of any homework or assignments.”
“I agree that, if our child should become involved in any trouble at school, or we disagree with any policy set by the school, we will not complain to others, but in the love of Christ and with prayer, we will register complaints with the teacher or principal.”
“I understand that my child is expected to take part in school activities and sponsored trips away from the educational facility. I hereby absolve the school from liability to me or my child because of injury to my child at properly supervised school activities.”
“I hereby assume my Scriptural responsibility for financial support and prayer of the school.”
“I understand that assessments will be made at the discretion of the school personnel to cover damage to school property caused by my child.”
“I have read and agree to support the statement of faith of Canon Christian Academy and its position paper on human sexuality.”
Father's and / or Mother's Signature
*
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