23/24 Jackson Park Baptist Academy Online Registration

Thank you for your interest in Jackson Park Baptist Academy. Registration fee is non-refundable.

Family Information

Parent/Guardian who will be primary contact:

Relationship to child:

Please select one option.

Father Mother Other

Primary phone number:

Secondary phone number:

This address will receive a confirmation email

Place of employment:

Parent/Guardian who will be secondary contact:

Relationship to child:

Please select one option.

Father Mother Other

Primary phone number:

Secondary phone number:

Place of employment

Child's primary address

Child's secondary address

Who has legal custody of the child?

Parents

Please select one option.

Together Separated

Church Home

Name and birth date of any Non-enrolling siblings

Name of enrolling student:

Class student is enrolling in

Please select one option.

2 year old preschool (Must be 2 by Aug. 31 2023) 3 year old preschool (Must be 3 by Aug. 31 2023) K4 year old preschool (Must be 4 by Aug 31 2023) Kindergarten (Must be 5 by Aug 31 2023)

Lives with:

Date of birth:

Age as of August 31, 2023

Gender

Please select one option.

Male Female

Registration Payment

Kindergarten Registration/Book Fee ($175 plus $7 convenience fee) (182.00) Preschool Registration/Book Fee ($125 plus $5 convenience fee) (130.00)

Amount

Office Use Only

Book Fee ________ Check_________ Receipt________ Enrolled________ FC-1

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Thank you for your interest in Jackson Park Baptist Academy. Registration fee is non-refundable.

23/24 Jackson Park Baptist Academy Online Registration

Description

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