Application – Heritage Christian Academy

Your Contact Email*
Enter Email Confirm Email
Applicant's Name*
First Last
Preferred/Nickname
Sex*
Candidate for*
Applicant's Home*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Birthdate*
MM
DD
YYYY
Birthplace*
Currently in School?
- Yes
Current School
Tell us about your child's current schooling situation.
Current Grade*
School Name
Grades Attended
Principal/School Head
First Last
Phone
Address
Street Address City State ZIP Code

Current Church
Regular attendance at a local church is required.
Church Name
Denomination
Family Information
Applicant Lives with*
- Both Parents
- Father is Deceased
- Mother is Deceased
- Parents are Divorced
- Father has Custody
- Mother has Custody
- Applicant is Adopted
- Parents are Separated
- Other
check all that apply
Father's Name*
Prefix First Last Suffix
Is Father Currently Employed?*
Occupation
Employer
Business Phone
Mother's Name*
Prefix First Last Suffix
Is Mother Currently Employed?*
Occupation
Employer
Business Phone
Parent's Address*
Street Address Address Line 2 City State ZIP Code
Does one parent live at a separate address?*
Other Address
Street Address Address Line 2 City State ZIP Code
Other Children
Name / Age / School
enter the name, age, and current school (if any) for any and all other children in the family.

Previous Educational Experience
Has the applicant ever skipped or repeated a grade?*
If so, please indicate the grade and circumstances.
Has the applicant ever received special tutoring?*
If so, please indicate the grade, subject and circumstances.
Has the applicant ever been suspended or dismissed from school?*
- Yes
- No
Describe any special circumstances which have affected his or her performance in school
(Such as illness, physical handicap, learning difficulty, change of residence or school, etc.)
Please list any prescribed medication(s) your child takes on a regular basis.*
Insulin, Ritalin, etc.
How did you hear about Heritage Christian Academy?*
Describe your child’s strengths, special areas of interest, academic achievements, and participation in athletics.*
Describe your child’s relationship with the Lord.*
Describe one or both parents’ relationship with the Lord.*
Does the student have an IEP (Individualized Education Program)?*
- Yes
- No
When would the student be available to begin classes?*

Statement of Faith
1. We believe that the Scriptures are the very Word of God in their entirety and, therefore, are our authority in matters of faith and practice.
2. We believe in one God, creator of the universe, eternally existing in the persons of the Father, the Son, and the Holy Spirit.
3. We believe that God created man in His own image, and when man disobeyed God, he fell from grace and brought sin into the world.
4. We believe that Jesus Christ was conceived by the Holy Spirit, born of the virgin Mary, crucified for our sin, and raised from the dead in eternal victory. He is undiminished deity and genuine humanity in one person.
5. We believe that the Holy Spirit is a personal Being who convicts the world of sin and who regenerates, indwells, empowers, guides, and seals believers eternally for God.
6. We believe that the regeneration by the Holy Spirit is absolutely necessary for the salvation of lost sinners, and those who receive the Lord Jesus Christ by faith are born again into the family of God.
7. We believe that the family of God is the church, which is the body of believers of which Christ is the head.
8. We believe that Heaven is the abode of God and the place of eternal joy for the saved, and Hell is the place of eternal punishment and separation from God for the lost.
Notice of Nondiscriminatory Policy

Heritage Christian Academy admits students of any race, color, sex, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, sex, national and ethnic origin in administration of its educational policies, admissions policies, scholarships, athletic and other school administered programs.
Statement of Faith*
- I have read and am in accordance with the above Statement of Faith of Heritage Christian Academy.

Current School

Current Church

Family Information

Other Children

Previous Educational Experience

Statement of Faith

Contact Information