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Online Application
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Student Information
Child's Full Name
*
First
Middle
Last
Gender
*
Male
Female
Date of Birth
*
Month
Day
Year
Grade Applying For
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
School Year Applying For
*
2025-26
New or Returning Student
*
New Student to FLA
Re-Enrolling Student to FLA
Allergies
Please list any known allergies. Additional details required on the student emergency forms.
Family Information
Child lives with
*
Both Parents
Mother
Father
Other
Names of Registered Siblings at FLA
Church (if any)
Enrolling Parent/Guardian Information
Enrolling Parent / Guardian
*
First
Middle
Last
Relationship to Child
*
Home Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Cell Phone
*
Email
*
Employer
*
Work Phone
Work Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent/Guardian Information
Parent / Guardian
*
First
Middle
Last
Relationship to Child
*
Home Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Cell Phone
*
Email
*
Employer
*
Work Phone
Work Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Tuition Agreement
Family Life Academy is a non-profit school; however, we have financial responsibilities that must be met throughout the school year. The intent of our tuition agreement is to ensure that we are able to continue to meet those obligations without incurring additional charges. Prompt payment of fees and tuition helps to keep our tuition costs down.
New Students
*
I agree to pay a non-refundable application fee of $75 for one child or $100 for two or more children.
We are a military family - Application fee will be waived
Initials
*
New & Returning Students
*
I am actively applying for tax credit scholarships to cover my child’s tuition. I understand that if my child’s tuition is not fully covered by scholarships, I will be responsible for the remaining balance at the end of the school year.
I have or plan to have a signed contract with ESA and I will request funds from ESA on a timely basis. I understand that should my child stop receiving ESA funds, I have the option to apply for scholarships and that I am responsible for the remaining balance at the end of the school year.
I plan to pay for my child’s tuition without scholarships or ESA funds. I agree to pay tuition in ten equal monthly installments which are due on the 1st of each month. I understand that payments will be considered past due on the 15th of each month and will incur a late fee of 10% of the outstanding balance. I will make all payments online through my FACTS account.
Initials
*
Media Release
I grant permission to Family Life Academy and Christ Community Church to use my child’s photograph or video on our website and/or other generated publications.
I hereby waive any right to inspect or approve the finished photograph, video, printed or electronic matter that may be used now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph.
I hereby agree to release, defend, and hold harmless Family Life Academy and CCC from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any misuse.
I understand this release and all contents, meaning, and impact. I have chosen to:
*
GRANT permission to Family Life Academy and Christ Community Church to use my child’s photograph or video on our website and/or other generated publications.
DECLINE permission to Family Life Academy and Christ Community Church to use my child’s photograph or video on our website and/or other generated publications.
Initials
*
Additional Documents
Please refer to the website to see which documents are required for your application.
These documents may be uploaded now or can be submitted to the office.
Student Emergency Information Form
Max. file size: 50 MB.
Copy of Birth Certificate
Max. file size: 50 MB.
Copy of Shot Record / Signed Exemption Form
Max. file size: 50 MB.
Affidavit of Intent for Private School (Needs Notarized)
Max. file size: 50 MB.
Signed Handbook Agreement Form
Max. file size: 50 MB.
Enrolling Parent/Guardian Signature
I acknowledge that I am the parent or legal guardian of the student named in this application. By providing my digital initials and electronic signature, I affirm that the information submitted is accurate and that I consent to the processing of this application. My electronic signature is legally binding and represents my full agreement to the terms of this application.
*
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