Enroll

Student Information

Please complete all fields in this section.

Student First Name(*)

Invalid Input

Student Last Name(*)

Invalid Input

Date of Birth(*)

Invalid Input

Gender(*)

Invalid Input

Grade Applying For(*)

Invalid Input

Student Status(*)

Returning StudentNew Student

Invalid Input

Parent/Guardian Information

Please provide the primary parent or guardian’s contact details.

First and Last Name(*)

Invalid Input

Relationship to Student(*)

Invalid Input

Primary Phone Number(*)

Invalid Input

Secondary Phone Number (Optional)

Invalid Input

Email Address(*)

Invalid Input

Mailing Address(*)

Invalid Input

Home Address(*)

Invalid Input

Parent/Guardian 2 (Optional)

Parent or Guardian 2 Name

Invalid Input

Relationship to Student (Parent or Guardian 2)(*)

Invalid Input

Parent or Guardian 2 Phone

Invalid Input

Parent or Guardian 2 Email

Invalid Input

Emergency Contact Information

Please provide a contact we can reach in case of an emergency.

Emergency Contact Full Name(*)

Invalid Input

Emergency Contact Relationship(*)

Invalid Input

Emergency Phone Number(*)

Invalid Input

Emergency Email Address_Optional

Invalid Input

Medical Information

Please provide accurate medical details to help us support your child’s health and safety.

Does the student have any allergies(*)

YesNo

Invalid Input

List Allergies

Invalid Input

Does the student take any medications(*)

YesNo

Invalid Input

List Medications

Invalid Input

Primary Physician Name

Invalid Input

Primary Physician Phone

Invalid Input

BirthCertificate(*)

Invalid Input

ImmunizationCard or Doctor approved exemption(*)

Invalid Input

ParentID(*)

Invalid Input

StudentPhoto_ Optional

Invalid Input

ReportCard_Optional

Invalid Input

TransferLetter_Optional

Invalid Input

Parent or Guardian Acknowledgment Statement

I hereby certify that all information provided in this enrollment application is true, complete, and accurate to the best of my knowledge. I understand that providing false or incomplete information may result in delays or denial of enrollment.

Invalid Input

School Policies Agreement(*)

I have read and agree to abide by all school policies, procedures, and expectations as outlined in the Parent/Student Handbook.

Invalid Input

Medical Authorization(*)

In the event of an emergency, I authorize Bethel Christian Academy staff to seek medical treatment for my child if I cannot be reached.

Invalid Input

Enrollment Fee Agreement(*)

I understand that my child’s enrollment application will not be processed until the non‑refundable $100.00 enrollment fee is paid with this form.

Invalid Input

Parent or Guardian Digital Signature(*)

Invalid Input

Date of Signature(*)

Invalid Input

Submit

Bethel Christian Academy

BCA Enrollment Form

Student Information

Parent/Guardian Information

Parent/Guardian 2 (Optional)

Emergency Contact Information

Medical Information

Main Menu

Parent Login

Login Form