Registration Form

Please fill out the registration form to enroll your child into Kingdom Come Academy for the new school year.

Please use laptop or desktop when filling form out.

Kingdom Come Academy a Private Education Association

Section 1 : Student Information

Last Name

Home Address

First Name

SSN

Middle Name

Birthday (MM-DD-YYYY)

Previous School Name

Primary Language

School Phone Number

School Address

Does your child has any health problem?

Does your child has any allergy?

Section 2 : Parent/Guardian Information - A

Last Name

First Name

Home Address

Relationship

SSN

Email

Secondary Number

Primary Cell Number

Section 3 : Parent/Guardian Information - B

*If both parents/guardians are present in the child's primary home, Section 3: Parent/Guardian Information B is required to fill out.

Last Name

First Name

Relationship

Home Address

SSN

Email

Secondary Number

Primary Cell Number

Section 4 : Emergency Contact - 1

Last Name

First Name

Home Address

Email

Relationship

Primary Cell Number

Best time to contact

Section 5 : Emergency Contact - 2

Last Name

First Name

Home Address

Email

Relationship

Primary Cell Number

Best time to contact

Section 6 : Emergency Contact - 3

Last Name

First Name

Home Address

Email

Relationship

Primary Cell Number

Best time to contact

By submitting this enrollment form, I hereby certify that all information contained herein, and all documents and information submitted via my online application materials or via any other form, are true, accurate, and complete to the best of my knowledge.

Parent/Guardian Name

Today's Date