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Request Information

Thank you for your interest in Light Christian Academy!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone
  • How Did You Hear About Us? *
    Details:

  • Does the caregiver have a history of incarceration (past or present)?
    * Yes   No
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *

  • Student age
    *

  • Current grade level:
    *

  • What school does your child currently attend?  If not currently attending, what was the last school your child attended?
    *

  • Does the child have any academic / behavior issues?
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •