Date of Last Upload:
Wednesday, July 2, 2025
Student Enrollment Form
New Student Information
Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information.
*
Required fields are bold.
Student's Information
Primary Family Information
Secondary Family Information
Contact Information
Submit Application
Student 1
*
Last Name
*
First Name
Middle Name
Preferred Name
*
REGISTERING FOR
<None>
Co-op
NSCA Cover School
Tiny Blessings
Suffix
<None>
Jr
TB
NSCA
*
Date of Birth (mm/dd/yyyy)
*
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Church Currently Attending
*
Allergies
<None>
Asthma
BBQ Sauce
Celiac Disease
Cerebral Palsy
Dairy
Eczema
Eggs
Grass
Insects
Milk
None
Peaches
Peanuts
Penicillin
Seasonal
Sulfa Drugs
Sweet Potatoes
Tree Nuts
ONLY COMPLETE THIS SECTION IF ENROLLING IN NORTH SHELBY BAPTIST CHRISTIAN ACADEMY-GRADES K-12
*
Grade Level
<None>
Pre-K
Infants
Ones
Twos
Threes
1st
2nd
Kindergarten
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Last Grade Completed
<None>
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
N/A
*
Previous School
CLICK BELOW TO ADD ANOTHER STUDENT
Student 2
*
Last Name
*
First Name
Middle Name
Preferred Name
*
REGISTERING FOR
<None>
Co-op
NSCA Cover School
Tiny Blessings
Suffix
<None>
Jr
TB
NSCA
*
Date of Birth (mm/dd/yyyy)
*
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Church Currently Attending
*
Allergies
<None>
Asthma
BBQ Sauce
Celiac Disease
Cerebral Palsy
Dairy
Eczema
Eggs
Grass
Insects
Milk
None
Peaches
Peanuts
Penicillin
Seasonal
Sulfa Drugs
Sweet Potatoes
Tree Nuts
ONLY COMPLETE THIS SECTION IF ENROLLING IN NORTH SHELBY BAPTIST CHRISTIAN ACADEMY-GRADES K-12
*
Grade Level
<None>
Pre-K
Infants
Ones
Twos
Threes
1st
2nd
Kindergarten
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Last Grade Completed
<None>
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
N/A
*
Previous School
CLICK BELOW TO ADD ANOTHER STUDENT
Student 3
*
Last Name
*
First Name
Middle Name
Preferred Name
*
REGISTERING FOR
<None>
Co-op
NSCA Cover School
Tiny Blessings
Suffix
<None>
Jr
TB
NSCA
*
Date of Birth (mm/dd/yyyy)
*
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Church Currently Attending
*
Allergies
<None>
Asthma
BBQ Sauce
Celiac Disease
Cerebral Palsy
Dairy
Eczema
Eggs
Grass
Insects
Milk
None
Peaches
Peanuts
Penicillin
Seasonal
Sulfa Drugs
Sweet Potatoes
Tree Nuts
ONLY COMPLETE THIS SECTION IF ENROLLING IN NORTH SHELBY BAPTIST CHRISTIAN ACADEMY-GRADES K-12
*
Grade Level
<None>
Pre-K
Infants
Ones
Twos
Threes
1st
2nd
Kindergarten
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Last Grade Completed
<None>
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
N/A
*
Previous School
CLICK BELOW TO ADD ANOTHER STUDENT
Student 4
*
Last Name
*
First Name
Middle Name
Preferred Name
*
REGISTERING FOR
<None>
Co-op
NSCA Cover School
Tiny Blessings
Suffix
<None>
Jr
TB
NSCA
*
Date of Birth (mm/dd/yyyy)
*
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Church Currently Attending
*
Allergies
<None>
Asthma
BBQ Sauce
Celiac Disease
Cerebral Palsy
Dairy
Eczema
Eggs
Grass
Insects
Milk
None
Peaches
Peanuts
Penicillin
Seasonal
Sulfa Drugs
Sweet Potatoes
Tree Nuts
ONLY COMPLETE THIS SECTION IF ENROLLING IN NORTH SHELBY BAPTIST CHRISTIAN ACADEMY-GRADES K-12
*
Grade Level
<None>
Pre-K
Infants
Ones
Twos
Threes
1st
2nd
Kindergarten
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Last Grade Completed
<None>
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
N/A
*
Previous School
CLICK BELOW TO ADD ANOTHER STUDENT
Student 5
*
Last Name
*
First Name
Middle Name
Preferred Name
*
REGISTERING FOR
<None>
Co-op
NSCA Cover School
Tiny Blessings
Suffix
<None>
Jr
TB
NSCA
*
Date of Birth (mm/dd/yyyy)
*
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Church Currently Attending
*
Allergies
<None>
Asthma
BBQ Sauce
Celiac Disease
Cerebral Palsy
Dairy
Eczema
Eggs
Grass
Insects
Milk
None
Peaches
Peanuts
Penicillin
Seasonal
Sulfa Drugs
Sweet Potatoes
Tree Nuts
ONLY COMPLETE THIS SECTION IF ENROLLING IN NORTH SHELBY BAPTIST CHRISTIAN ACADEMY-GRADES K-12
*
Grade Level
<None>
Pre-K
Infants
Ones
Twos
Threes
1st
2nd
Kindergarten
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Last Grade Completed
<None>
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
N/A
*
Previous School
CLICK BELOW TO ADD ANOTHER STUDENT
Primary Family Information
*
Address Line 1
Address Line 2
*
City
*
State
*
ZIP Code
Home Phone
Home Listed
*
Mobile Phone
Mobile Listed
Parent 1 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Jr
TB
NSCA
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
TB
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Mobile Phone
Mobile Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Parent 2 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Jr
TB
NSCA
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
TB
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Mobile Phone
Mobile Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Secondary Family Information
*
Address Line 1
Address Line 2
*
City
*
State
*
ZIP Code
Home Phone
Home Listed
*
Mobile Phone
Mobile Listed
Parent 3 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Jr
TB
NSCA
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
TB
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Mobile Phone
Mobile Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Parent 4 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Jr
TB
NSCA
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
TB
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Indian
Native American
Polish
*
Home E-Mail
*
Mobile Phone
Mobile Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Contact Information (Other than parents)
Contact 1
*
Last Name
*
First Name
*
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Grandchild
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Mobile Phone
Pickup Tag
Pickup Notes
Contact 2
*
Last Name
*
First Name
*
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Grandchild
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Mobile Phone
Pickup Tag
Pickup Notes
Contact 3
*
Last Name
*
First Name
*
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Grandchild
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Mobile Phone
Pickup Tag
Pickup Notes
Medical Contacts
Physician
Physician Phone Number
Hospital
Hospital Phone Number
Insurance
Insurance Phone Number
Finished
Confirmation E-Mail address:
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