User – Roxboro Christian Academy

Enroll Student

AcceptPOE

I understand and agree with the RCA Philosophy of Education

AcceptSOF

I understand and agree with the RCA Statement of Faith

CFirstName

CMiddleName

CLastName

Cdob

Child's Gender

Grade Applying For

Has Your Child Attended Another School

SchoolName

SchoolPhone

Submit your child's most recent report card

RecentReportcard

Parent 1 Relationship

Parent 1 First Name

Parent 1 Middle Name

Parent 1 Last Name

Parent 1 Street Address

Parent 1 City

Parent 1 State

Parent 1 Zip

Parent 1 Phone Number

Parent 1 Email

Parent 1 Occupation

Parent 1 Employer

Parent 1 Employer Phonenumber

Parent 1 Employer Address

Parent 2 Relationship

Parent 2 First Name

Parent 2 Middle Name

Parent 2 Last Name

Parent 2 Street Address

Parent 2 City

Parent 2 State

Parent 2 Zip

Parent 2 Phone Number

Parent 2 Email

Parent 2 Occupation

Parent 2 Employer

Parent 2 Employer Phonenumber

Parent 2 Employer Address

ChruchAttended

ChurchPhone

Who attends?

ChurchReference

RefPhone

RefAddress

EmergencyContact

EmergencyContactNumber

Relationship To Student

Allergies

HealthConcerns

Meds

Fears

PrimaryCareName

OfficeNumber

HospitalPref