New Member Enrollment Form

Primary Teaching Parent
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Cell Phone and/or Home Phone*
Home Church Name*
Occupation or Work Experience*
Number of years homeschooling?*
How did you hear about LCA?
- Website
- MPE Newsletter or Conference
- Friend/Family
- Other
Referred by current LCA family? If yes, family name?
Spouse
Name*
First Last
Cell Phone and/or Home Phone*
Email*
Occupation or Work Experience*

Student Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Choose one:*
Grade Level for 2024-2025*
Curriculum Used?*
Allergies/Concerns
Additional Student, if applicable
Please be sure to include nursery and preschool children
Name
First Last
Date of Birth
MM slash DD slash YYYY
Choose one:
Grade Level for 2024-2025
Curriculum Used?
Allergies/Concerns
Additional Student, if applicable
Please be sure to include nursery and preschool children
Name
First Last
Date of Birth
MM slash DD slash YYYY
Choose one:
Grade Level for 2024-2025
Curriculum Used?
Allergies/Concerns
Additional Student, if applicable
Please be sure to include nursery and preschool children
Name
First Last
Date of Birth
MM slash DD slash YYYY
Choose one:
Grade Level for 2024-2025
Curriculum Used?
Allergies/Concerns
Additional Student, if applicable
Please be sure to include nursery and preschool children
Name
First Last
Date of Birth
MM slash DD slash YYYY
Choose one:
Grade Level for 2024-2025
Curriculum Used?
Allergies/Concerns
Additional Student, if applicable
Please be sure to include nursery and preschool children
Name
First Last
Date of Birth
MM slash DD slash YYYY
Choose one:
Grade Level for 2024-2025
Curriculum Used?
Allergies/Concerns
Comments:

Primary Teaching Parent