Columbia Adventist Academy
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Application
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                                                                Columbia Adventist Academy


              Application for Admission School Year ________
Pupil's Legal Name

Last

First

Middle

Nickname
 
Address

No. and Street

City

State

Zip
 
Place of Birth

City

State

Date of Birth

Age: Years,      Months
 
 

Email Address

Sex

Social Security Number
 
Last School Attended
Grade Completed 
 
 

No. and Street

City

State

Zip
 
 
Church Affiliation of Student Date of Baptism
 
Family Information Father Mother Guardian  
Legal Name        
Check One Natural Step Foster Natural Step Foster Relationship to Child:
 
Home Address if Different from Above  
Home Phone  
Home Email  
Occupation  
Years of Education  
Business Address  
Business Phone  
Business Email  
Birth Date  
Birth Place  
U.S. Citizen Yes No Yes No Yes No  
SDA Member Yes No Yes No Yes No  
Marital Status Mar Div Mar Div Mar Div  
I give consent for my child’s picture to appear on the C.A.A. Website / Promotional Brochures ◊Yes       ◊No
I give my consent for my child to be included in the C.A.A. Directory / Yearbook                     ◊Yes       ◊No
We have read the Columbia Adventist Academy Handbook and willingly agree to abide by all rules and regulations stated therein. 
I,(Student) agree to abide by the Columbia Adventist Academy Handbook        ◊Yes         ◊No
____________________________                 ____________________________________________
Student Signature            Date                                    Parent Signature                                         Date
 
 

241 Riverchase Way • Lexington, SC, 29072-9470 • 803-796-0277