CKCA 2024-25 Student Registration

Registration Instructions

Please complete the following registration form to ensure the CKCA office has the most current contact information for your student(s).

On this student registration form, you can register up to 3 students! Select "Do you have 2 (or 3) students attending CKCA?" at the end of completing Child # 1 information, and an additional section will appear to complete for another student.

If any of the parent contact or emergency contact information is different from student to student, then you would need to complete separate student registration forms.

Please note, this student registration form is the only form out of the 4 online forms that you can complete for more than 1 student! The additional 3 forms (financial, student forms and medical) will need to be completed for each student individually.

Child #1 Information

CKCA Student Enrollment *

New CKCA Student	Returning CKCA Student	Kindergarten CKCA Student
Only Enrolling in CKCA Electives

Student First Name *

Student Middle Name *

Student Last Name *

Age: years (age student will be on Aug 31) *

Birthdate * +

Social Security Number *

Grade going into 2024-25 school yr *

Last School Attended *

Affiliated Church *

Child lives with: *

Are there are COURT-MANDATED custody/visitation orders limiting access to this student? *

Gender *

Demographics *

Do you have a 2nd student attending CKCA? *

Child #2 Information

CKCA Student Enrollment #2 *

Returning CKCA Student	New CKCA Student	Kindergarten CKCA Student
Only Enrolling in CKCA Electives

Student First Name #2 *

Student Middle Name #2 *

Student Last Name #2 *

Age: years (age student will be on Aug 31) #2 *

Birthdate #2 * +

Social Security Number #2 *

Grade going into 2024-25 school yr #2 *

Last School Attended #2 *

Affiliated Church #2 *

Child lives with: #2 *

Are there are COURT-MANDATED custody/visitation orders limiting access to this student? #2 *

Gender #2 *

Demographics #2 *

Do you have a 3rd student attending CKCA? *

Child #3 Information

CKCA Student Enrollment #3 *

Returning CKCA Student	New CKCA Student	Kindergarten CKCA Student
Only Enrolling in CKCA Electives

Student First Name #3 *

Student Middle Name #3 *

Student Last Name #3 *

Age: years (age student will be on Aug 31) #3 *

Birthdate #3 * +

Social Security Number #3 *

Grade going into 2024-25 school yr #3 *

Last School Attended #3 *

Affiliated Church #3 *

Child lives with: #3 *

Are there are COURT-MANDATED custody/visitation orders limiting access to this student? #3 *

Gender #3 *

Demographics #3 *

Mother/Guardian Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home/Cell Phone Number *

Employer

Work Phone Number

Email Address *

Father/Guardian Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home/Cell Phone Number *

Employer

Work Phone Number

Email Address *

Emergency Contacts

Please list names of persons in close proximity to the school to whom we may release your child or contact if you cannot be reached. No student will be released to anyone other than the parents, guardians, adults listed without additional consent.

Emergency Contact #1

Emergency Contact Name *

Phone Number *

Secondary Phone Number

Email Address (if wanting to add to Warrior Web News & other CKCA communications)

Relationship to Child *

Grandparent

Neighbor

Friend

Family member or Other (please indicate relationship) Family member or Other (please indicate relationship)

Emergency Contact #2

Emergency Contact Name *

Phone Number *

Secondary Phone Number

Email Address (if wanting to add to Warrior Web News & other CKCA communications)

Relationship to Child *

Grandparent

Neighbor

Friend

Family member or Other (please indicate relationship) Family member or Other (please indicate relationship)

Emergency Contact #3 (Optional)

Emergency Contact Name

Phone Number

Secondary Phone Number

Email Address (if wanting to add to Warrior Web News & other CKCA communications)

Relationship to Child

Grandparent

Neighbor

Friend

Family member or Other (please indicate relationship) Family member or Other (please indicate relationship)

Elective Classes (please SKIP over this section if your child will be a FULL TIME student)

Please Select which electives you would like your child to enroll in

Referral

If you are new to CKCA, how did you hear about us? *

If you are new and were referred by a current CKCA student/family, please list the CKCA student/family name:

Student Handbook & Discipline Agreement

We have read the student handbook in its entirety and agree to follow the guidelines and expectations as parents/guardians and as a student of Central Kansas Christian Academy. Also, we acknowledge the rules and procedures of the Central Kansas Christian Academy Discipline Plan. We agree to the terms given and acknowledge the consequences that will occur when inappropriate behavior is displayed. Central Kansas Christian Academy does not and shall not discriminate on the basis of race, color, religion, gender (male or female, according to biological status at birth), age, national origin (ancestry), disability, marital status, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. *

I agree to the above statement

Signature of parent/guardian completing form: *

clear

Date form is Completed: * +