Family information

Mailing Address: City: Prov: Postal Code: 

Father/Guardian’s Name: Mother/Guardian’s Name: 

Home Phone: () -- Work Phone: () --

FAX: () --

When is the best time to contact you?

Has any member of the family ever been enrolled in LCA; if so, who?

Student information

Student’s Name: Gender:   Male Female Birth date: 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY/MM/DD

Does the student plan to earn a high school diploma from LCA?  Yes No

Last School Attended: Last Grade Completed? 1 2 3 4 5 6 7 8 9 10 11 12 13 When?

School Address: City: Province: Code:

Phone: () -- FAX: () -- Contact Person: 

Was Accelerated Christian Education used? Yes No

If so, please list last PACE completed: Math English Social Studies Science Word Building

Electives (Please Specify) 

Please list other information regarding the student’s past history that may be of assistance to the LCA Advisor:

To enrol additional students, please repeat paste into the body of your email and fill in form again before sending.

Please send the following items for each student to be enrolled:

Method of Payment

**NOTE:  We will call for Credit Card Numbers, please do not include in email.**

Cheque Money Order Visa Master Card American Express  Name as it appears on the Credit Card:   

  $75 One-Time Registration Fee per Family                                                                 $

$250 Tuition Fee per Student 1-8 Grade Level  *      X    Number of Students =    $

$300 Tuition Fee per Student 9-12 Grade Level  *    X    Number of Students =    $

                                                                                                             Total Enclosed =    $

** Note**  The above tuition fee is for one year and must be paid in full prior to ordering your first term of PACE's

Enrollment Agreement

  I, the signee, am entirely responsible for the payment of all fees, both service and curriculum, charged to this account.  To the best of my knowledge, I have answered correctly all parts of the application. 
 I understand a school year is for a maximum of 12 months.  If I do not plan to re-enrol my child the following year, but wish to have my child complete their remaining PACES, $50 a month must be paid up front for Lighthouse Christian Academy to record any finished work that I send in after my enrolment date.
 I further understand that my student is to be supervised during study time by a parent or a responsible adult who will not allow cheating or copying of answers from the Score Keys and Test Keys by keeping them in a secure place.
  I agree to submit completed and graded PACE Tests at the end of each quarter (or every 3 months).  I realize that a credit will not be given if the original PACE Tests are not sent in or that a score of 80% or better is not attained.
  In order for enrolment to be processed, I realize that Registration and Tuition Fees must accompany this signed application.  I further realize that Registration and Tuition Fees are non-refundable.

Parent/Guardian:   Date: MM/DD/YYYY