Enrollment Form

New Student Application

By submitting this form, you are officially applying for admission to Columbia Academy. Your information will be reviewed and presented to our Board for approval.

If you are not yet ready to apply and would like to learn more about our campus and programs, we encourage you to request a tour first using our Inquire Form

Signature(Required)

I have read and agree to the above statement.

School Year(Required)

Enrollment Type(Required)

New Enrollment (Never Attended CA)

Re-Enrollment (Attended CA in the Past)

Grade Level(Required)

If K3, how many days will the student be attending?(Required)

Three days

Five days

Have You Toured Our School?(Required)

Yes

No

Student's FULL Name(Required)

First Middle Last Suffix

Preferred Name(Required)

Home Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Age(Required)

Please enter a number from 2 to 20.

Birth Date(Required)

Gender(Required)

Male

Female

Do You Currently Have Any Children Attending CA?(Required)

Yes

No

Previous School Information

School Attended Last Year(Required)

Phone Number of School(Required)

Address of School(Required)

Street Address City State ZIP Code

Parent / Guardian

FATHER'S Name(Required)

First Last

Employer(Required)

Business Phone(Required)

Cell Phone(Required)

Email(Required)

MOTHER'S Name(Required)

First Last

Employer(Required)

Business Phone(Required)

Cell Phone(Required)

Email(Required)

If Parent's are separated or divorced, with whom does the child live?

Please List 3 References From Families At CA

(If You Do Not Have Any Please Skip)

Emergency Information

Emergency Contact Name(Required)

First Last

Cell Phone(Required)

Relationship to Child(Required)

Payment Plan(Required)

Ten Month (Aug 1- May 1)

Twelve Month (June 1- May1)

Bus Registration(Required)

Yes

No

Comments

This field is for validation purposes and should be left unchanged.

New Student Application

Previous School Information

Parent / Guardian

Emergency Information

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