GENESIS ACADEMY

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1 Student Info
2 Parent/Guardian Info
3 Health Info
4 Parent/Guardian Agreement
GENESIS ACADEMY ENROLLMENT APPLICATION

Student's Information

Gender

SCHOOL HISTORY

Please list schools in chronological order

Parent/Guardian Information

Parent/Guardian 1

Gender

Parent/Guardian 2

Gender

Health Information

Is The Child Covered by Health Insurance?

Emergency Contacts Other Than Parent or Guardian

In the case that hospitalization is necessary please indicate which hospital you wish your child to be taken to:

State child’s general health:

Please select any of the following conditions your child may have suffered from the list provided on the right.
Is the child potty trained?
Does this child wear spectacles?
Is this child under special medical care?
Does this child routinely take medication?
Any problems, which may adversely affect ability to study?
Any known allergies to medication?

PARENT/GUARDIAN AGREEMENT FORM

Check all below in agreement with our Parent/Guardian Agreement
I have read and agree to abide by the policies and guidelines as outlined in the Student/Parent Handbook.
Clear Signature
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VISION

To see children oriented Biblically, motivated creatively, communicate effectively, work collaboratively, and think critically while utilizing innovative pedagogies to foster growth academically, socially, and spiritually.

MISSION

To be an educational institution dedicated to the upholding of high standards of Biblical truth and morality, the achieving of excellence with consistency in academics, culture, arts and sports, the nurturing of personality in creativity and service, and the inculcation of principles for building good character and loyal citizenship.