Haysi Campus Application | Wise County Christian School

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Haysi Campus Application

Step 1 of 4

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Student Information
Student's Full Legal Family Name*
Student's First & Middle Name*
First Middle
Entering Grade*
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Mailing Address*
Street Address City State ZIP Code
Student Transferred From:*

Parent/Guardian A Information
Parent/ Guardian 1 Name*
First Middle Last
Relationship*
Contact Number*
Email Address*
Do you have another Parent/ Guardian to add?*
- Yes
- No

Parent/Guardian B Information
Parent/ Guardian Name*
First Middle Last
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*
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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