2026-2027 Student Application | Lancaster Christian Academy

Acknowledgement

Please be sure the information below is accurate. A non-refundable enrollment fee of $100.00 must accompany this form. Current immunization records (DHEC 4024) and a copy of the student's birth certificate must be turned in prior to the first day of school.

Student's Full Name:

First

Middle

Last

Student's Preferred Name:

Student's Gender:

Male
Female

Student's Date of Birth:

Student's Current Grade:

Student's Grade in 26-27:

Acknowledgement

Kindergarten students must be five before September 1, 2026.

Student's Mailing Address:

City:

State:

ZIP:

Preferred Contact Name:

Preferred Contact Number:

Preferred Method of Communication:

Text
Phone Call
Class Dojo
Email

Preferred Contact Address (if different from above):

Parent 1 Name:

Parent 1 Phone:

Parent 1 Email:

Parent 1 Employer:

Parent 2 Name:

Parent 2 Phone:

Parent 2 Email:

Parent 2 Employer:

Who does the student live with?

Both Parents
Parent 1
Parent 2
Other

If other, please provide additional information.

Are there any current custody issues?

Yes
No

Acknowledgement

If yes, LCA must have copies of legal documents on file if there are any circumstances of which we need to be aware. Please let us know if there is someone who SHOULD NOT pick up your child.

For billing purposes, who shold bills be sent to?

Both Parents
Parent 1
Parent 2
Other

If other, please provide additional information.

Who is authorized to pick up your child?

First

Last

Relationship:

Phone Number:

Who is authorized to pick up your child?

First

Last

Relationship:

Phone Number:

Who is authorized to pick up your child?

First

Last

Relationship:

Phone Number:

List previous schools/programs attended and indicate which grade attended:

Does your student have a current IEP (individualized education plan)?

Yes
No

Acknowledgement

If your child has a current IEP (individualized education plan), please submit a copy of the IEP with this enrollment application

Has your student ever received special services at previous schools?

Yes
No

If yes, please explain what services and length of time.

Does your family attend church? If yes, which church?

Does your child have any allergies? If yes, please list the allergies and instructions for how to handle these.

Has your child had any major health issues in the past? If yes, please explain.

Student's Who information.

Does your student have a current chronic illness or health issue. If yes, please explain.

Does your student take daily medication? If yes, please list medications.

Does your student have a physical or learning disability that has been diagnosed? If yes, please explain.

Does your child have any dietary restrictions? If yes, please explain.

Do you have any concerns about your student in any of the following areas?

Please explain any concerns you have in more detail:

Student's Primary Physician:

Student's Primary Dentist:

Health Insurance Provider:

Please include the name of a teacher, administrator, or pastor who is willing to serve as a reference for your student and family:

First

Last

Reference Phone Number:

Reference Email Address:

Parent/Guardian Certification

By checking this box, I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submission of this application does not guarantee admission to Lancaster Christian Academy. I agree to provide any additional documentation requested by the school and understand that false or misleading information may result in denial of admission or dismissal from the Academy.