Columbia Adventist Academy Application for Admission - please print in landscape format
Grade Completed
Church Affiliation of Student
In an emergency, if parents can't be reached, call: We have read the Columbia Adventist Academy Handbook and
willingly agree to abide by all rules and regulations stated therein.
Pupil's Legal Name
Last
First
Middle
Nickname
Address
No. and Street
City
State
Zip
Place of Birth
City
State
Date of Birth
Age: Years, Months
Email Address
Sex
Social Security Number
Last School Attended
No. and Street
City
State
Zip
Date of Baptism
Family Information
Father
Mother
Guardian
Legal Name
Check One
Natural
Step
Foster
Natural
Step
Foster
Relation to Child:
Home Address if Different from Above
Home Phone
Home Email
Occupation
Years of Education
Business Address
Business Phone
Business Email
Birth Date
Birth Place
U.S. Citizen
Yes
No
Yes
No
Yes
No
SDA Member
Yes
No
Yes
No
Yes
No
Marital Status
Mar
Div
Mar
Div
Mar
Div
I give consent for my child's picture to be published on the CAA website:YesNo
I give consent for my child to be included in the CAA Directory:YesNo
Name
Phone
Signed
Mo. Day
Yr.
Signed
Mo. Day Yr.