(Please fill out one per student)

Church School Enrollment Form

School Year: _________________ Public School District: ______________________

 I.  TO BE COMPLETED BY PARENT OR GUARDIAN

Student's Full Legal Name:  ____________________________________________________
Street or Mailing Address (please specify):  ________________________________________________
City/State/ZIP:  ________________________________________________________
Home Phone + area code:  (______)_____________________________________________________
Date of Birth:  ________________________  Grade:  ___________________________
Parent or Guardian's Name:  ______________________________________________
Address (if different):  ________________________________________________________
Home Phone (if different):  _____________________________________________________
Church School of Enrollment:  Sacred Grove Academy
Address:  P.O. Box 3338, Phenix City, Alabama 36868
School Phone:  229-669-5991

Signature of Parent or Guardian:  ____________________________________________

(NOT VALID UNLESS SIGNED BY PARENT)
Date:  __________________________________________________________________

II.  TO BE COMPLETED BY CHURCH SCHOOL ADMINISTRATOR

Church School:  Sacred Grove Academy
Address:  P.O. Box 3338, Phenix City, Alabama 36868
School Phone:  229-669-5991
Date of Student Enrollment:  ____________________ for _______________ school year

Signature of Administrator:  ________________________________________________

(NOT VALID UNLESS SIGNED BY ADMINISTRATOR)
Date:  __________________________________________________________________

III.  CONSENT FOR NOTIFICATION OF STUDENT WITHDRAWAL

I hereby give prior consent to the administrator of  the above named church school to notify the public school superintendent should the above named student cease attendance at said school.

Signature of Parent or Guardian:  _____________________________________________

(NOT VALID UNLESS SIGNED BY PARENT)
Date:  __________________________________________________________________

Many thanks to AICSA (Alabama Independent Church School Association) for this form!

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