Faith Baptist Christian Academy

Enrollment Application

Complete form, print, and mail to:
FBCA, 1515 Wistar Road, Fairless Hills, PA 19030, along with a check for $35.00 for the application fee. Thank you!
Submission of this application is non-binding.

GENERAL INFORMATION

Student's Last Name: First Name: Middle:

Mailing Address:

Actual Street Address:

Nearest Intersection:

Home Telephone: School District:

Birthdate: Social Security Number: Sex:

FAMILY INFORMATION

Father: Work Phone:

Mother: Work Phone:

Marital Status: Both Parents Separated Divorced Widowed Single

Student Resides With: Both Parents Mother Father Other

Grandparents' Names (one set):

Grandparents' Address:

CHURCH AFFILIATION What church do you attend? Member? Yes No

Church Address:

Pastor's Name: Phone:

BROTHERS AND SISTERS

Name	School Attending	Current Grade

SCHOOL INFORMATION

Entering grade for the school year.

Name of School: Phone:

Address:

Why are you considering changing schools?

How did you hear about Faith Baptist Christian Academy?

Date: Signature of Parent or Legal Guardian: __________________________