Parent Guardian Name *

Email *

Phone *

Preferred Contact Method *

Phone Call

Text

Email

Address

Street Address *

City *

State *

Country

Enter your country

Postal Code *

Student Name *

Date Of Birth *

Age *

Grade Entering *

Current Grade *

Current School Attended  *

Does Your Child Have Siblings Who Will Attend *

If Yes What Are Their Names Ages and Grades *

What Interests You Most About Life Changers Learning Academy? *

Small Class Sizes

Christian Education

Individualized Learning

Character Development

Academic Support

Flexible Learning

Safe Environment

Leadership Development

Other

Will You Be Using An Arizona ESA Scholarship *

Enrollment Interest *

Has Your Child Ever been: *

Does Your Child Currently Have an IEP or 504 Plan? *

Anything You'd Like Us To Know About Your Child? *

When Are You Hoping To Enroll? *

Immediately

This Semester

Next Semester

Just Exploring

How Did You Hear About Us *

Final Consent *

I Understand This Form Is An Inquiry And Does Not Guarantee Enrollment

I consent To Be Contacted By Life Changers Learning Academy By Phone, Email, or Text Regarding Admissions And Enrollment