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Roxboro Christian Academy
Equipping Students for Life Through Christ-Centered Education
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Home
About Us
Contact Us
Resources
Safe Resources for kids
Document Center
School Calendar
Donations
[ultimatemember form_id=”336″]
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
Child's gender
Male
Female
Grade Applying For
Grade applying for
K3
K4
K
1
2
3
4
5
6
7
8
9
10
11
12
Has Your Child Attended Another School
Has your child attanded another school
No
Yes
SchoolName
SchoolPhone
Submit your child's most recent report card
RecentReportcard
Parent 1 Relationship
Relationship to Student
Mother
Father
Stepfather
Stepmother
Grandmother
Grandfather
Legal Guardian
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
Relationship to Student
Mother
Father
Stepfather
Stepmother
Grandmother
Grandfather
Legal Guardian
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?
Mother
Father
Grandmother
Grandfather
Legal Guardian
Child
ChurchReference
RefPhone
RefAddress
EmergencyContact
EmergencyContactNumber
Relationship To Student
Relationship To Student
Mother
Father
Grandfather
Grandmother
Stepmother
Stepfather
Family Friend
Allergies
HealthConcerns
Meds
Fears
PrimaryCareName
OfficeNumber
HospitalPref
submit ⟶