Mount Bethel Christian Academy Enrollment

Please fill in all current information for all students enrolling, parent information, pick up list (emergency contacts) and general documents. You may pause at the end of each section and return to complete your application.

1Student #1 Info > 2Student #2 Info > 3Student #3 Info > 4Student #4 Info > 5Parent #1 Info > 6Parent #2 Info > 7Pickup List > 8Gen Doc Uploads/Sig > 9Review Your Entry
Student #1 Information
First Name *
Middle Name *
Last Name *
Suffix
Preferred/Called By Name

If applicable
Entering Grade Level *
Date of Birth * / MM / DD YYYY
Gender *
Ethnicity *
SSN#

Enter number here
Academic Information

List all schools the student has previously attended (Beginning with the most recent)
PREVIOUSLY ATTENDED SCHOOLS - most recent
School Name
City
ZIP
Years Attended

Enter School Year, e.g.: 2016/17, 2015/16, etc.
Grade (s)

Grade Level, e.g.: K5, 1st, 2nd, etc.
PREVIOUSLY ATTENDED SCHOOL - 2nd recent
School Name
City
ZIP
Years Attended

Enter School Year, e.g.: 2016/17, 2015/16, etc.
Grade (s)

Grade Level, e.g.: K5, 1st, 2nd, etc.
PREVIOUSLY ATTENDED SCHOOL - 3rd recent
School Name
City
ZIP
Years Attended

Enter School Year, e.g.: 2016/17, 2015/16, etc.
Grade (s)

Grade Level, e.g.: K5, 1st, 2nd, etc.
STUDENT PROFILE
A) Has your child ever repeated a grade? *
YES NO
If yes, which grade.
B) Has your child ever been suspended or or dismissed from a school? *
YES NO
If yes, please explain.
C) To the best of your knowledge, has your child been involved with alcohol, drugs, tobacco, cheating, stealing, or sexual immorality? *
YES NO
If yes, please explain.
D) Does your child have any special challenges? (i.e.: learning disablities, discipline,etc.) *
YES NO
If yes, please explain.
E) Has your child ever been enrolled in a special education program/classes? *
YES NO
If yes, please explain.
F) Please name some of your child's special skills or interests
G) What is the reason for your child not continuing at her/his present school? *
Student Lives With *
Father Mother Both Other
Church Affiliation *
Request for Documents

The official form required for requesting transcripts and information from your child's previous school is located on the Mount Bethel Enrollment page. Please download, complete and sign, then scan into your computer/device and upload by pressing the button below.

Alternatively, you may complete the form manually and bring it into the school office.
Please upload a copy of your completed & signed "Request for Documents" form here.

Attach Files Attach Files
Parent Log In Information

This email address is used for parents to log into MySchoolWorx to see grades and homework. If an email address is given, please enter a password. Passwords require at least 1 uppercase letter, 1 lowercase letter, a number, and must be 8 characters or longer. Log in will only be available after the office has processed the student.
Parents's Email
Password
Minimum of 8 characters required. Currently Entered: 0 characters.
Swim Central Water Safety Education Questionnaire

Complete, sign and upload the Program Registration form found on our website in order for your child to participate in the Swim Safety Education Program.

Alternatively, you may print and complete the form manually and bring it into the school office.
Upload a copy of your completed & signed "Swim Central Water Safety" form here.

Attach Files Attach Files
Health/Medical Information

Please provide the basic medical information as requested below for this student. All enrolling students must have current immunization records and a physical.
Physician's Name: *
Physician's Practice Name:
Physician's Practice Address: *
Physician's Phone Number: *
Health Insurance Name: *
Policy Number: *
Please upload a copy of your insurance card.

Attach Files Attach Files

Front and back. Alternatively, you may make a manual copy and bring it into the school office.
STUDENT MEDICAL PROFILE / CONDITIONS
Blood Type
Does your child have a medical condition? *
YES NO
If yes, describe/explain:
Does your child take any medications regularly? *
YES NO
If yes, please list all medications your child takes regularly.
Does your child have any allergies? *
YES NO
If yes, please list all known allergies.
Are there any foods your child cannot eat? *
YES NO
If yes, please list all foods your child cannot eat.
Emergency Treatment Authorization

If emergency treatment is required (under any circumstances), and the parents or legal guardian cannot be reached immediately, my signature below empowers the school's authorities to exercise their own judgement in administering treatment, calling the student's physician, or if not available, to call 911 EMERGENCY SERVICES. I will not hold the school financially responsible for the emergency care and/or transportation for my child. I authorize the release of medical records pertinent to such an emergency room visit - files may be needed by the medical institution. This is a general authorization and is not sufficient for release of confidential information protected by Federal Law.
Parent/Legal Guardian Name: *
I agree to the above Emergency treatment Authorization *
YES NO
Parent/Legal Guardian Signature *

Clear
Please sign by drawing your signature into the box.
Enroll Another Student? *
Yes No
Save my progress and resume later
Enter Your Email Address

A special link to resume the form will be sent to your email address.

Mount Bethel Christian Academy Enrollment

Mount Bethel Christian Academy Enrollment

Student #1 Information

Academic Information

Request for Documents

Parent Log In Information

Swim Central Water Safety Education Questionnaire

Health/Medical Information

Emergency Treatment Authorization