Student's Legal Name*

First

Last

Gender*

male

female

Date of birth*

Place of birth*

Age*

Grade applying for*

ESL?*

yes

no

Form of document**Gr K-1 to verify date of birth

birth certificate

passport or visa

notarized statement

hospital statement

Home address*

Address 1

Address 2

City

State

Postal Code

Country

Race/Ethnicity*

Primary Language*

Student living with*

mother

father

stepmother

stepfather

grandma

grandpa

If other please specify

Parent/Gaurdian A*

First

Last

Relationship*

Responsible for financial statments?*

yes

no

Parent/Guardian A Email*

Home Phone*

Cell Phone

Work Phone

Occupation*

Religious Preference*

if SDA, church

Primary Language

Parent/Guardian B

First

Last

Parent/Guardian B Email

Relationship

Responsible for financial statements?

yes

no

Home phone

Cell phone

Work phone

Occupation

Religious preference

If SDA, church

Primary language

School(s) last attended*if you are not a returning student

I have read and understand the Kona Adventist Christian School including the section on finance. I understand and fully accept my obligations.*

I agree

Electronic Signature*

Date of submission

mm/dd/yyyy

Seventh-Day Adventist Church

Kona Adventist Christian School A Seventh-day Adventist School

Registration Form

KACS Christmas Party 2021

School year 2021-2022