Columbia Adventist Academy
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Application
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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