TCA Application Please complete the form below or print the PDF version for offline completion. Print PDF Application Child’s Legal NameGrade EnteringFirst ChoiceSecond ChoiceThird ChoiceHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Birth MM slash DD slash YYYY AgeGenderMaleFemaleAllergiesMedicationsSpecial Conditions or Learning DisabilitiesParent(s) or Guardian(s) Contact InformationFather's NameFather's Address Same as Child's Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Father's PhoneFather's Email Father's OccupationFather's Business PhoneMother's NameMother's Address Same as Child's Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mother's Email Mother's PhoneMother's OccupationMother's Business PhoneParents' Marital StatusMarriedDivorcedSeparatedFamily InformationDoes the child live with both parents?YesNoPlease explain the home conditions in which the child is living.What church do you attend?How often do you attend your church?WeeklyBi-MonthlyMonthlyOccasionallyHave you trusted Jesus Christ as your personal Savior? Parents Students Have you read the “Statement of Faith”?YesNoSchool RecordsLast School AttendedLast School: PhoneLast School: Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Has your child ever failed a grade?YesNoWhich GradeK51st2nd3rd4th5th6th7th8th9th10th11th12thHas your child ever been suspended, dismissed, or expelled from a school?YesNoPlease explain, giving the school name and datesEmergency and Pick Up Permission ListPersons, in order, to contact in case of an emergency if parents or guardians cannot be reached.Contact 1 - NameContact 1 - PhoneContact 2 - NameContact 2 - PhoneContact 3 - NameContact 3 - PhonePersons with permission to pick up your child (not already listed):Acknowledgment I agreeI hereby acknowledge that I am financially responsible for the above named student. I acknowledge that upon my child’s enrollment into Timberline Christian Academy, a ministry of Timberline Baptist Church, my child and I will abide by all of the policies, rules, and regulations of the school set forth in the school handbook.Father's SignatureMother's SignaturePlease provide the name if you were referred by a family member whose child is currently enrolled in Timberline Christian Academy.
