Application


		Christian Star Academy

	7 East Sugar Street Mount Vernon, Ohio 43050 740-393-0251





	Click on the Electro Bricks, above, to see a special video our First Lego League Team created (with the help of a few MVNU students) to remind us to be prepared.

Please complete this application.

This is not a commitment but a tool to help the administrator, Miss Sue, communicate with you.

Application

Date Time

YYYY

Child's Full Name:
First - Middle - Last *

Child Called by Parents: *

Birthdate *

YYYY

Child's Current Age:

Child's Sex:

Home Address: *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Home Phone:

###

####

Referred to CSA by:

Father's Name: *

Prefix

First *

Last *

Suffix

Father's Cell Phone #:

###

####

Father's Email:

Father's Occupation *

Father Employed by: *

Father's Business Phone #:

###

####

Father's Hobbies: *

Please list all interests and hobbies.

Mother's Name *

Prefix

First *

Last *

Suffix

Mother's Cell Phone#:

###

####

Mother's Email

Mother's Occupation: *

Mother Employed By: *

Mother's Business Phone #:

###

####

Mother's Hobbies: *

Please list all interests and hobbies.

Family Church *

Phone

###

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Reference # 1: *

Name - Relationship - Phone #

Reference # 2: *

Name - Relationship - Phone #

Reference # 3: *

Name - Relationship - Phone #

Child lives with: *

Both Parents

Mother

Father

Grandparent(s)

Other

If other, please state relationship:

Legal Guardian, Aunt, Court Appointed Guardian, etc.

List Siblings: *

Name - Sex - Birthdate - Age - Name of current school

Reason you are interested in Christian Star Academy *

Tell us a little about your child: *

Personality, likes, dislikes, school experience, etc.

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