Seale Christian Academy

Student Application

Please complete all sections below. Fields marked with * are required.

Student Information

Student Full Name *

Preferred Name

Birth Date *

Gender

Grade

Incoming Year / Semester

Current School

Current Grade Level

Application Remarks

Parent First Name *

Parent Last Name *

Email Address *

Contact Number

Home Phone

Cell Phone

Fax

Street Address

City

State

ZIP Code

Country

List any medical problems the student has as well as any medication currently being taken below.

Medical Problems

Medical Needs

List any allergies the student has below.

Medication Allergies

Food Allergies

Other Allergies

List any additional medical information for the student e.g. dietary needs, etc. below.

Special Dietary Needs

Other Information