Student Pre-Enrollment Application Please enable JavaScript in your browser to complete this form.Student Name *FirstLastGrade going into *Select gradeK-51st2nd3rd4th5th6th7th8th9th10th11th12thAge *Gender *MaleFemaleDate of Birth *Student's AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent 1 InformationNameFirstLastEmail AddressPhone NumberPhone TypeMobileOtherParental StatusFatherMotherOtherMarital StatusMarriedSeperatedDivorcedSingleOtherParent 2 InformationStatusNot ApplicableNameFirstLastEmail AddressPhone NumberBackground InformationHow did you hear about Liberty Baptist Christian Academy?Why do you wish to enroll your child at LBCA?If applicant is applying for 7th-12th grade, does he/she also desire to be a student at Liberty Baptist Christian Academy?YesNoNot ApplicableWhy or why not?Does the applicant have any allergies, physical disabilities, or health problems? YesNoIf the applicant has any of the above disabilities, please explain:Has the applicant ever been suspended or expelled from a school?YesNoIf applicant has been suspended or expelled from a school, please describe the circumstances:Does applicant have a 504 or IEP?YesNoIf the applicant has a 504 or IEP please describe the nature of their education plan.:Submit
