Columbia Adventist Academy Lexington SC : Application

Columbia Adventist Academy

Application

Columbia Adventist Academy

Application for Admission
Print in landscape format.

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

Grade Completed

No. and Street

City

State

Zip

Church Affiliation of Student

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

In an emergency, if parents can't be reached, call:	Name	Phone

We have read the Columbia Adventist Academy Handbook and willingly agree to abide by all rules and regulations stated therein.

Signed

Mo. Day Yr.

Signed

Mo. Day Yr.

241 Riverchase Way • Lexington, SC, 29072-9470 • 803-796-0277