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Parent/Gaurdian Information

Mother/Legal Guardian’s name*

First Last

If Legal Guardian, relationship to student

Preferred Phone*

Mother/Legal Guardian’s cell*

Preferred Email Address*

(please note that this email will be used for all SHA correspondence and should be checked regularly)

Father’s name

First Last

Fathers’s cell

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marital Status*

Is there a restraining order? If so please explain.*

Church Name*

Church City

Church Denomination

Is someone other than a parent or legal guardian the primary supervising adult during normal school hours?

Supervising Adult’s name*

First Last

Supervising Adult’s relationship to the student*

Supervising Adult’s Phone*

Supervising Adult’s Email*

Parent/Gaurdian Agreement*

I agree

I hereby understand and agree with the statements above and attest to the verity of the information provided throughout this application.

Signature*

After submitting this portion of the Application you will be prompted to fill out the student portion.