Grades 7 to 11 Admission Form
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Please print this form and mail it to: #5 Grove Drive West, Spruce Grove, AB T7X 3X8. You may also download the Microsoft Word version of this document by clicking here.
Living Waters Christian Academy
Student Profile
For Secondary Students - Grades 7-12
School Year ________-________
All new secondary students are requested to complete this student profile form and include it with the Application for Admission.
1. Name:_____________________________________________Date:______________
(Surname first middle)
Birthdate: _____________________Age______
(month / day / year)
Address:_____________________________________________________________
_____________________________Postal Code:___________Phone:____________
2. Name of Father____________Mother_______________Guardian_______________
Address(if different from above)__________________________________________
Father’s Occupation:_______________ Mother’s Occupation:__________________
Grade previously in/or completed:_____ Enrolling in Grade________
Have you ever had to repeat a grade? _____ Which grade was it? _______
School last attended:___________________________ Ph.#____________________
Address: ____________________________________________________________
Home Room Teacher:__________________________________________________
3. Are your parents professing Christians?______ Regular Church Attenders?________
Church family attends:__________________________Ph.#____________________
4. Print clearly the names of two adult references: (no relatives)
a. Name:_________________________________Phone #_____________________
b. Name:________________________________Phone # _____________________
5. Health: Good?_______ Fair? ______ Any chronic or recurring illness? ___________
If so, give details: _____________________________________________________
Do you have any physical handicap that limits you in normal school activities? _____
If so, give details: ______________________________________________________
6. List contacts that led you to apply to LWCA. ________________________________
____________________________________________________________________
7. Why do you want to attend LWCA? What do you expect to gain from attending a Christian High School? ___________________________________________________________________
______________________________________________ ____________________
8. Have you accepted Jesus Christ as your personal Lord and Saviour? _____________
9. On a separate sheet, write a brief account of your life, using the following headings:
a. If “yes” to #8, submit a short, handwritten testimony.
b. School experience: ie. How did you do? How did you like?
What were some of your strengths and weaknesses then?
c. Family life and environment: relationship with parents, occupation of parents,
names and ages of brothers and sisters.
d. What do you think you can contribute to our school?
e. Please submit copies of report cards for the previous two years.
10. Personal Convictions:
Please answer regarding you participation in the following:
a. Television : I watch approximately ____ hours per week.
My favourite show is _____________________________________________.
b. Music Interests: the music I listen to would be classed as: (Give one example from each class.)
Western ___ Classical ___ Folk Music ___ Rock ___ Hard Rock ___ Other
Examples of artists: _____________________________________________
Sacred Instrumental ____ Sacred Vocal ____
Examples of artists: _____________________________________________
Music Preference: Instrumental ____ Vocal ____ Orchestration ____
c. Dance Attendance: Yes ____ No ____ If yes, how often?_______________
Last occasion: ____________________________
d. Movie Theatre Attendance: Yes _____ No ____ If yes, how often? ________
Last occasion: ______________What movie? _________________________
e. Use of cigarettes: Yes ____ No ____ If yes, last occasion? ______________
f. Use of narcotics: Yes _____ No ____ If yes, last occasion? _____________
g. Use of alcohol: Yes ____ No ____ If yes, last occasion? ________________
h. Gambling: Yes ____ No ____ If yes, explain: ________________________
11. Personal Responsibilities include:
a. At home (chores);
washing dishes ____ cleaning room ____ babysitting ____ other ___________
b. At church: ______________________________
regular Attendance: Yes _____ No ____ ; Youth Activities: Yes ____ No ____
Teach Sunday School ____ Young People’s ____ Boys & Girls Club ____ Choir ____ Other _________________________________________________
c. At School I’ve been involved in :
Student Council ____ Sports Council ____ Christian Club ____ Team(s) _____
Classroom Help ____ Other _________________________________________
12. List hobbies, interests or leisure-time activities: ____________________________
________________ ________________ ______________ ________________
13. Goals :
a. What are your present long range goals for the future? ___________________
_______________________________________________________________
b. What are your immediate goals and/or present life purpose? ie. What would you like to see happen in your life in the next year?
_________________________________________________________________
14. Have you ever been:
Involved with police? No ____ Yes ____ Explain: ________________________
_________________________________________________________________
On school probation: No ____ Yes _____ Explain: ________________________
_____________________________ ____________________________________
Please have your pastor complete the reference form and return it directly to the school.
The responses given represent as fully and correctly as I know the relevant information for me to be considered as student a LWCA. Misrepresentation will result in refusal of admission.
Signature of student: ___________________________________ Date: ______________
This site is maintained by Gordon Poultney, a parent of the school.