Haysi Campus Application

Student Information

Student's Full Legal Family Name*

Student's First & Middle Name*

Entering Grade*

Date of Birth*

Gender*

Male

Female

Mailing Address*

Street Address City State ZIP Code

Student Transferred From:*

Parent/Guardian A Information

Parent/ Guardian 1 Name*

Relationship*

Contact Number*

Email Address*

Do you have another Parent/ Guardian to add?*

Yes

No

Parent/Guardian B Information

Parent/ Guardian Name*

Relationship*

Contact Number*

Email Address*

Other Information

Acknowledgement

I acknowledge that this application does not guarantee enrollment in Wise County Christian School - Haysi Campus. I understand this is an initial assessment of interest and if there is sufficient enrollment interest for the Haysi Campus to proceed I will be required to complete a more in-depth application form upon my child's acceptance. This application will remain on file until enrollment is either offered or denied.

Parent/Guardian Signature*

Date*

CAPTCHA

Student Information

Parent/Guardian A Information

Parent/Guardian B Information

Other Information

Acknowledgement

Wise County Christian School

5913 Airport Rd., Wise, VA 24293-3297

(276) 328-3297

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