GRACE VALLEY CHRISTIAN ACADEMY 27173 Road 98, Davis, California 95616 // (530) 758-6590 phone/fax PRELIMINARY ENROLLMENT APPLICATION

Answer all questions in this application completely.  You may attach additional pages if necessary.

Parent/Guardian Information

Father's name (last, first, middle): _______________________________________________________

Marital status:     Married     Separated     Remarried     Deceased    Other (explain)

Home address:________________________________________________________________________

City:_______________________________________  State:___________    Zip code:_______________

Home phone: (   )__________________________   Business phone: (   )___________________________

Father's employer:______________________________________________________________________

Mother's name (last, first, middle):________________________________________________________ 

Marital status:    Married    Separated    Remarried    Deceased    Other (explain)

Home address:________________________________________________________________________

City:_______________________________________  State:___________    Zip code:_______________

Home phone: (   )__________________________   Business phone: (   )___________________________

Mother's employer:______________________________________________________________________

Church Information

Name of church:_______________________________________   Pastor:_________________________

Address:_______________________________________________________________________________

City:_______________________________________  State:____________    Zip code:_______________

Student Information

Number of children in family:_________  List ages:___________________________________________

1. Name:_____________________________   Birthdate:______________ Grade entering:____________

Place of birth (city, state, country):___________________ S.S. #: _______________________________

School last attended:__________________________________   Dates:___________________________

Special needs or disabilities (please specify):_________________________________________________

Areas of difficulty:_______________________________________________________________________

Student's interest or skills:________________________________________________________________

2. Name:_____________________________   Birthdate:______________ Grade entering:____________

Place of birth (city, state, country):___________________ S.S. #: _______________________________

School last attended:__________________________________   Dates:___________________________

Special needs or disabilities (please specify):_________________________________________________

Areas of difficulty:_______________________________________________________________________

Student's interest or skills:________________________________________________________________

3. Name:_____________________________   Birthdate:______________ Grade entering:____________

Place of birth (city, state, country):___________________ S.S. #: _______________________________

School last attended:__________________________________   Dates:___________________________

Special needs or disabilities (please specify):_________________________________________________

Areas of difficulty:_______________________________________________________________________

Student's interest or skills:________________________________________________________________

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