2020-2021 Registration Application 4th-12th Grade
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Email *
Student's Last Name *
Student's first name *
Grade in Fall of 2020-21* *
Gender *
Student email
Mother's name (first and last) *
Mother's primary phone number *
Father's name (first and last)
Father's primary phone number
Alternate phone number for parents
Email(s) to receive Ecclesia and/or Protégé communications *
Emergency Contact (Name, relationship, phone) *
What is your school of record *
Do you intend to pay for classes with charter fees (Please also specify, later in the form, when choosing each class whether you will be using charter funds to pay) *
Math/Period 1 -  Tu/Th 9-10 *
Required
Science/Period 2 (Tu/Th 10-11) *
Required
PE, Art & Worldview/Period 3 (Tu/Th 11-12) *
Required
Language Arts/Period 4 *
Required
Social Studies/Period 5 *
Required
Monday Electives - 7th and up *
Required
For what classes do you plan to pay with charter funds? (check all that apply) *
Required
I have read an understood the Registration Terms of Agreement *
Required
Signed: *
Is there anything else you would like us to know?
Include your mailing address below.   *
A copy of your responses will be emailed to the address you provided.
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