Application For Enrollment

Thank you for choosing Crossroads Christian Academy. Please complete this enrollment application to the best of your ability. We will contact you within 48 hours of submitting this form to work with you to collect the following additional information:

  • Activities fee and a non-refundable registration fee accompanying application

  • Immunization records

  • Proof of age

  • An interview with parents or guardian (Crossroads does not discriminate on the basis of race, color, birth biological sex, or nationality.)

Name of Student *
Name of Student
Home Phone *
Home Phone
Home Address *
Home Address
Student's Birth date *
Student's Birth date
Birth Biological Sex *
Used for State reporting
Requested Date for Enrollment *
Requested Date for Enrollment
Father's Cell Phone Number
Father's Cell Phone Number
Mother's Name
Mother's Name
Mother's Cell Phone Number
Mother's Cell Phone Number
Step Parents Phone Number
Step Parents Phone Number
Guardian's Phone Number
Guardian's Phone Number
Is there a court order in effect? *
If Yes, please describe
Is your student transferring from another school?
Enrollment in grades 1-8 requires a transfer of records from the student's previous school. Please indicate the school your child is transferring from., if applicable.
Address
Address
Classification Date
Classification Date
Doctors Office Phone
Doctors Office Phone
Please provide the name of one individual who can speak as a reference for your family.
Reference Phone *
Reference Phone
Grandparents Address (1)
Grandparents Address (1)
Grandparents Address (2)
Grandparents Address (2)