Student Full Name

Student Date of Birth

Grade Applying For

Gender

Male

Female

Home Address

County of Residence

Previous School (if applicable)

Last Grade Completed

Parent/Guardian #1 (Name, Phone, Email)

Parent/Guardian #2 (Name, Phone, Email)

Primary Contact

Emergency Contact 1 (Name, Relationship, Phone)

Emergency Contact 2 (Name, Relationship, Phone)

West Virginia Required Records

State Birth Certificate (copy)

Immunization Record (as required by WV law)

Physical Examination Record (Well-visit, including hearing and vision screening)

Dental Examination Record

Previous School Records/Transcript (if applicable)

Compulsory Attendance Acknowledgment

West Virginia law requires school attendance for children ages 6–17.

By signing below, I/We acknowledge that enrollment at Crusade Christian Academy fulfills compulsory attendance requirements and agree to ensure regular student attendance.

Answer

Academic Information

Does your child have any diagnosed learning needs?

Yes

No

If yes, please explain

Does your child have an IEP or 504 Plan from a public school? Note: Private schools in West Virginia are not required to provide the same special education services as public schools but may offer accommodations at their discretion.

Yes

No

Student Behavior & Discipline History

Has the student ever been suspended or expelled?

Yes

No

If yes, please explain

Does the student have any behavioral or emotional concerns?

Yes

No

If yes, please explain

Medical Information

Allergies

Medical Conditions

Medications

Physician Name and Phone Number

Spiritual Background

Church Attended (if applicable)

Pastor's Name

Does your family attend church regularly?

Yes

No

Briefly describe your family's faith commitment:

Parent Agreement & School Compliance Statement

I/We understand that Crusade Christian Academy is a private, faith-based school operating in accordance with West Virginia law governing nonpublic education.

I/We agree to:

Provide all required records for enrollment

Support school policies, including attendance and discipline

Partner with the school in my child’s academic and spiritual development

Signature (By typing name), Date

Records Release Authorization

I/We authorize the release of all academic, attendance, and health records from the previous school to Crusade Christian Academy.

Signature (By typing name), Date

Student Application

Compulsory Attendance Acknowledgment

Academic Information

Student Behavior & Discipline History

Medical Information

Spiritual Background

Parent Agreement & School Compliance Statement