Online Application Step 1 of 5 - STUDENT INFORMATION 20% For Grade*SelectKindergarten1st2nd3rd4th5th6th7th8thSchool DistrictToday's Date Name* First Middle Last Home Address* Street Address Address Line 2 City State / PR ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home Phone*Date of Birth* Gender*MaleFemaleRaceAsianBlackCaucasianNative AmericanHispanicRequested by NYS Mother's InformationMother's NameOccupationEmployerWork PhoneCell PhoneFather's InformationFather's NameOccupationEmployerWork PhoneCell PhonePrimary Email* Child Lives With*Marital Status of Parent(s)*SelectSingleMarriedDivorcedSeparatedWidowed Present Grade*SelectNonePreschoolKindergarten1st2nd3rd4th5th6th7th8thCurrent School*School Address* Street Address Address Line 2 City State / PR ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Has your child ever been recommended for any type of specials needs class?*YesNoIf yes, please describe: Is your child currently receiving additional help outside the classroom such as tutoring, reading help, speech or language therapy?*YesNoIf yes, please describe: Has your child had any problems with discipline at school?*YesNoIf yes, please describe: First person to contact in an emergency:*Relation to child:*Phone*Second person to contact in an emergency:Relation to child:PhoneDoes your child have any allergies or other health conditions?*YesNoIf yes, please describe: Child's DoctorPhoneDo you have other children currently applying to CCA?*YesNoNameGradeSelectKindergarten1st2nd3rd4th5th6th7th8thNameGradeSelectKindergarten1st2nd3rd4th5th6th7th8thNameGradeSelectKindergarten1st2nd3rd4th5th6th7th8th Do you regularly attend Calvary Chapel of the Finger Lakes?*YesNoIf yes, how long have you been in regular attendance?Which services do you attend?Sun. 8:30amSun. 10:30amSun. 6:30pmWed. 7pmMake multiple selections by Ctrl+click (PC) or Cmd+Click (Mac)Do you attend another church?YesNoIt yes, where?Please list the ministries and activities that you are involved in at your church: Parents: Please describe briefly, your personal relationship to Jesus Christ:* Parent completing this section:*Parents: What do you see as your biblical responsibility in your child’s education? Also, why do you want your child(ren) at CCA?* Parent completing this section:*Students applying for grades 3 through 8: Please write a brief statement describing your personal relationship with Jesus Christ. Also, why do you wish to attend Calvary Chapel Academy?* Student Signature (Typed)*Parent Signature (Typed)*I certify to the best of my ability that the information throughout this application is complete and accurate.Date All applicants must submit copies of their their most recent report cards as well as report cards from all previous years. All applicants must include copies of their most recent standardized test scores, and any IEP or 504 information. Have a pastor who knows you well complete the Pastoral Reference Form. Acceptance will only be considered once all required items have been received and the student has met with one of our faculty. Mailing address for attachments: Calvary Chapel Academy P.O. Box 25099, Farmington, NY 14425