TCA Re-Enrollment 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-MonthlyMonthlyOccasionallyEmergency 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 re-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.
