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Haysi Campus Application

"*" indicates required fields

Step 1 of 4

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Student Information

Student's First & Middle Name*
MM slash DD slash YYYY
Gender*
Mailing Address*

Parent/Guardian A Information

Parent/ Guardian 1 Name*
Do you have another Parent/ Guardian to add?*

Parent/Guardian B Information

Parent/ Guardian Name*

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.
MM slash DD slash YYYY

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Wise County Christian School

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5913 Airport Rd., Wise, VA 24293-3297

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(276) 328-3297

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