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Preschool

Application for Faith Baptist Academy

FBA Application

Applicant Information

APPLICANT INFORMATION (Student)

Applicant's Full Name:

Name Applicant is Called (Nickname):

Country of Origin:

Applicant's Sex:

Male

Female

Applicant's Date of Birth:

Applicant's Full Street Address:

Applying for Grade:

Kindergarten

1st

2nd

3rd

4th

5th

6th

Summer Camp Only

Applicant's Current Health Insurance Provider:

Name of the Primary Insured:

Has applicant applied for any of the following funds?

Utah Fits All Scholarship

Children's First Educational Fund

Please list the names of any siblings also applying for FBA:

Church applicant is regularly attending:

Parental Information

PARENT & FAMILY INFORMATION

Full Name of Applicant's Father:

Father's Email:

Father's Preferred Phone:

Father's Work Phone:

Father's Full Street Address:

Full Name of Applicant's Mother:

Mother's Email:

Mother's Preferred Phone:

Mother's Work Phone:

Mother's Full Street Address:

Check any that apply to applicant:

Father deceased

Mother deceased

Parents are divorced*

Parents are separated*

File upload statement

If parents are separated or divorced, please provide a copy of the current custody documents by upload at the end of this form, or in person at the school office.

Emergency Contact Name:

Emergency Contact Phone:

Educational Background

APPLICANT'S EDUCATIONAL BACKGROUND

Name of last school applicant attended:

Has applicant ever been referred for academic evaluation testing, tutoring, developmental delays etc.?

Yes

No

If yes, please provide FBA with a copy of the evaluation/testing results and state the reason below:

Has the applicant ever been suspended?

Yes

No

If yes, please describe whether in-school, out of school, or both and the reason(s) for suspension:

Has the applicant ever been expelled, excluded or denied entry to another school?

Yes

No

If yes, please explain the circumstances:

Medical Information

APPLICANT MEDICAL INFORMATION

Applicant's Pediatrician/Primary Physician:

Physician's Phone:

Physician's Office Full Street Address:

Medication Prescriptions:

Health Conditions:

Parent Signature:

PARENT SIGNATURE

By typing my name and the date below, I certify that I agree to digital signatures and have answered the questions on this application truthfully and fully. I understand that failure to disclose the requested information may result in immediate dismissal of my child from Faith Baptist Academy.

Full Name:

Date:

File Uploads:

Click Here to upload docs

Doc Upload Types

Files may include birth certificate, vaccination records, test results, parental docs, etc.

Thanks for applying to Faith Baptist Academy. We will review your information and get back to you as soon as possible.

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CONTACT

Phone: 801-771-0308

Email: fbautahoffice@gmail.com

Address: 2430 N Fairfield Rd, Layton, UT 84041, USA

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