SONshine Christian Academy

Address:
Liberty Baptist Church
3791 Meyer Rd.
Owensville, MO 65066
(314) 808-4299
ejcampbell1@hotmail.com

Student Application

STUDENT NAME:

DATE OF BIRTH:

Student grade level for 24/25 school year:

Student Address:

Student Gender: Male Female

Father's name:

Father's cell phone number:

Father's place of employment and work phone number:

Mother's name:

Mother's cell phone number:

Mother's place of employment and work number:

Other guardian's name:

Other guardian's phone number:

Other guardian's place of employment and work number:

Emergency contact name and phone number:

Please list anyone (other than parents or guardians) who are allowed to pick up the student upon presenting a valid ID:

Sibling(s) name(s) and grade level(s):

Is there any other information SCA should know about? (Example lives with grandparents or alternative weeks with divorced parents.):

Please list any allergies, medical conditions, or other medical needs that SCA needs to be aware of:

Medical insurance company and policy number:

Physician’s name and phone number:

Preferred hospital:

What church does the student regularly attend?

Name of Pastor:

Church contact information:

Does the student have an IEP? Yes No

Does the student have a 504? Yes No

What school(s) has the student attended?

Registration fee: $200.00 to cover any educational items necessary. This is non-refundable. I agree

Tuition is $300.00 per month for all students. I agree