Campus Student Application - Wellmont Academy

Student Application for K-12 Campus

Thanks for your interest in attending Wellmont Academy. Please fill out this application and we will notify you of the next steps. Please note, a $25 non-refundable application fee is required for submission of all applications.

Step 1 of 6

Parent/Guardian Information
Main Contact Email*
Enter Email Confirm Email
Father's Name*
First Last
Father's Employer
Father's Occupation
Father's Mobile Phone Number*
Father's Mobile Carrier (for school-wide texts)*

Example: AT&T, T-Mobile, etc..
Father's Email*
Photo of Father*
Accepted file types: jpg, jpeg, png, Max. file size: 256 MB.
Mother's Name*
First Last
Mother's Employer
Mother's Occupation
Mother's Mobile Phone Number*
Mother's Mobile Carrier (for school-wide texts)*

Example: AT&T, T-Mobile, etc..
Mother's Email*
Photo of Mother*
Accepted file types: jpg, jpeg, png, Max. file size: 256 MB.

How did you hear about Wellmont?*
Do you have a Statement of Faith?*
Briefly state your faith beliefs as specifically as possible.

References
Non-family Reference 1*
Please list the name of someone (non-family) who knows you and your child well.
First Last
Phone*
Reference 2 Email*
Non-family Reference 2*
Please list the name of someone (non-family) who knows you and your child well.
First Last
Phone*
Reference 2 Email*

Emergency Contacts
Emergency Contact 1*
Person other than parent/legal guardian who is to be contacted in case of emergency. This person must be local and from a separate household than Emergency Contact 2.
First Last
Relationship*
Phone*
Emergency Contact 2*
Person other than parent/legal guardian who is to be contacted in case of emergency. This person must be local and from a separate household than Emergency Contact 1.
First Last
Relationship*
Phone*
Medical Information
Please list any medical concerns, psychological evals, or psychiatric care we should be aware of. If none, please type "N/A".*

Student Application for K-12 Campus

Step 1 of 6

Student Information

Address Information

Parent/Guardian Information

References

Emergency Contacts

Medical Information

School Information

Evaluations and official documents

Notices of Values and Rights

Notice of Rights

School Name	Date Started Attending	Length of Attendance in Years