Legacy Christian School, Inc.

8780 19th Street #214 Alta Loma, California 91701 Phone (909) 429-9484

Registration or Renewal Registration

School Year 2008-2009

Family Information
Family Name _____________________________________________________________________________________
Last Name Husband’s Legal First Name Wife’s Legal
First Name

Name as you wish it to appear on nametags

_________________________________________________
Husband Wife

Home Address
_________________________________________________________________________
Street City State
Zip Code
Mailing Address (if different from above)
Student Information (Please list ALL children living in the home.)
Full Legal Name Nickname Sex Birthdate Grade Enrolling in
Legacy?

_______________________ _________ ____ __________ ______ Yes ____ No ___

_______________________ _________ ____ __________ ______ Yes ____ No ___
_______________________ _________ ____ __________ ______ Yes ____ No ___
_______________________ _________ ____ __________ ______ Yes ____ No ___
_______________________ _________ ____ __________ ______ Yes ____ No ___
List names of any children enrolling in Legacy who have learning challenges; or (a) have had an IEP
(Individualized Education Program) written; or (b) have been diagnosed privately, or within the school
system, as having learning disabilities, learn with difficulty, or have problems with traditional teaching
methods.
________________________________________________________________________________________________
Parent Information
________________________________________________________________________________________________
Father’s Employer: ____________________________________________________________________
________________________________________________________________________________________________
City _________________________________Telephone _________________ Cell _________ ____________
Medical
Mother’s Information The school does not pay physician fees or medical expenses of students
Employer: __________________________________________________________________
injured at school-sponsored activities. In the rare event of a medical emergency at an activity where
City _________________________________ Telephone _________________ Cell _________ ____________
the parents Legacy Christian School, Inc.
are not present, this release is needed to allow proper treatment and give permission to
administer treatment.
If one biological parent does not live at child’s address, list his/her address here:
IName
hereby authorize first aid, ambulance, doctor and/or hospital care as deemed
_____________________________________________ Telephone _________________ Cell ___________________
appropriate for my child(ren) as listed on the first page of this registration form.
(Check (include
Address appropriate choices.)
city and zip code)
_______________________________________________________________________
You may _____ /may not ______ administer Aspirin ______ Tylenol ______ Advil _______ .

Authorized Signature _____________________________________________________________

Emergency Contacts: (List two contacts other than parents.)

Name __________________________________ Relationship ___________________ Phone# _______________

Transfer of Records If your child is transferring into Legacy from another school,
we will send for his/her cumulative file. Please complete the following for new students.
Provide complete addresses.

Legal Name of Student Birthdate Grade Name and address of last

school attended

___________________________________ _______________ _______ ______________________________________

___________________________________ _______________ _______ ______________________________________
___________________________________ _______________ _______ ______________________________________

Faculty Information This section provides us with information on teacher

qualifications.
At Legacy Christian School, we support the fact that a child’s parents are the final authority in decisions for their children’s
education and are fully capable
of teaching their own children.

Student(s) will be taught by (provide name of teaching parent)

_________________________________________________
Does the above person have a current CA teaching credential? no ______ yes ______
If yes, then check one of the following: primary _______ secondary _______ special education
________

Name/address/telephone of additional teachers (other than spouse)

____________________________________________
_________________________________________________________________________
PAYMENT INFORMATION:
New Registration $100.00 ____________
Office Use Only Open Period: May 1-July 31, deduct $25.00
Renew Registration $ 35.00
Date Received ____________
_______________ After 7/31 pay $75.00
Faculty Information
Amount High School Surcharge $ 20.00 /yr
Student will be taught by (name of primary
_______________ parent-
____________
Checkteacher)__________________________________________
# _______________
AddedDoes the_______________
to DB above person have a CAAdditional
teachingHigh Schoolers:
credential?_____ @ $10.00 each ____________
Sent for FilesNo___
_______________
Yes___ K-8 ___Prepaid
9-12___ K-12___
QuickHow
Books (IN FULL) Tuition (10% discount)
many years has the above person____________
homeschooled grades K-12? ______________
Name/address/telephone of any (Prepayment
secondarydeadline
teacher (other 15
is September than
th
)
spouse).________________________________
TOTAL REGISTRATION DUE $
Please list any additional training or experience received in recent years.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
___