2021-2022 Family Contacts and Student Information

2021-2022 Family Contacts and Student Information

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• Your Name*
  First Last
• Your Email*
• 2021-2022 Enrolled Students*
  How many students do you have enrolled at LCA for the 2021-2022 school year?
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
• Future Eagles*
  Do you have children you wish to enroll at LCA in the future? The LCA Future Eagles program is designed to allow families to share their intended partnership with us early. No matter if your child is 6 months old and interested in joining us for PreK-3 or just finishing Middle School and interested in joining us for high school, we’d like to get to know you now!
  • Yes
  • No
• LCA Alumni Update*
  Do you have any alumni for whom you would like to provide us an update?
  • Yes
  • No
• Parent/Guardian Count*
  How many parent/guardians are associated with your child(ren) including yourself?
  • 1
  • 2
  • 3
  • 4
• Grandparent Contact Updates*
  Please select the number of grandparents for whom you wish to update contact information?
  • None
  • 1
  • 2
  • 3
  • 4
• Emergency Contact Updates*
  Please select the number of emergency contacts for whom you wish to update information.
  • None
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
• Database Contact Removal
  If you would like us to remove an emergency or if a grandparent has passed away, and you would like us to update our records, please type their names below.

• Parent/Guardian 1 Information*
  First Last
• Date of Birth*
  MM slash DD slash YYYY
• Role*
  Please select one role listed below.
  • Mother
  • Father
  • Step Mother
  • Step Father
  • Legal Guardian 1
  • Legal Guardian 2
• Email*
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell Phone*
• Home Phone*
• Work Phone*
• Address*
  Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Employer Name
  Please provide us with the name of this parent/guardian's employer.
• Communication Preferences*
  Please select your communication preferences for this parent/guardian.
  • No Emergency Alert
  • ALL Emergency Alert Options
  • Emergency Alert: Cell Phone
  • Emergency Alert: Home Phone
  • Emergency Alert: Work Phone
  • Emergency Alert: Text Notification
• Directory Preferences*
  Please select your school directory preferences for this parent/guardian.
  • Include Name, Address, and Phone Numbers
  • Directory Block: Name
  • Directory Block: Address
  • Directory Block: Cell Phone
  • Directory Block: Home Phone
• Gradebook Notification Preferences*
  Please select your gradebook notification preferences for this parent/guardian.
  • Weekly: Auto Email Gradebook
  • Daily: Auto Email Gradebook
  • Never: Auto Email Gradebook
• Parent/Guardian 2 Information*
  First Last
• Date of Birth*
  MM slash DD slash YYYY
• Role*
  Please select one role listed below.
  • Mother
  • Father
  • Step Mother
  • Step Father
  • Legal Guardian 1
  • Legal Guardian 2
• Email*
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell Phone*
• Home Phone*
• Work Phone*
• Address*
  Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Employer Name
  Please provide us with the name of this parent/guardian's employer.
• Communication Preferences*
  Please select your communication preferences for this parent/guardian.
  • No Emergency Alert
  • ALL Emergency Alert Options
  • Emergency Alert: Cell Phone
  • Emergency Alert: Home Phone
  • Emergency Alert: Work Phone
  • Emergency Alert: Text Notification
• Directory Preferences*
  Please select your school directory preferences for this parent/guardian.
  • Include Name, Address, and Phone Numbers
  • Directory Block: Name
  • Directory Block: Address
  • Directory Block: Cell Phone
  • Directory Block: Home Phone
• Gradebook Notification Preferences*
  Please select your gradebook notification preferences for this parent/guardian.
  • Weekly: Auto Email Gradebook
  • Daily: Auto Email Gradebook
  • Never: Auto Email Gradebook
• Parent/Guardian 3 Information*
  First Last
• Date of Birth*
  MM slash DD slash YYYY
• Role*
  Please select one role listed below.
  • Mother
  • Father
  • Step Mother
  • Step Father
  • Legal Guardian 1
  • Legal Guardian 2
• Email*
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell Phone*
• Home Phone*
• Work Phone*
• Address*
  Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Employer Name
  Please provide us with the name of this parent/guardian's employer.
• Communication Preferences*
  Please select your communication preferences for this parent/guardian.
  • No Emergency Alert
  • ALL Emergency Alert Options
  • Emergency Alert: Cell Phone
  • Emergency Alert: Home Phone
  • Emergency Alert: Work Phone
  • Emergency Alert: Text Notification
• Directory Preferences*
  Please select your school directory preferences for this parent/guardian.
  • Include Name, Address, and Phone Numbers
  • Directory Block: Name
  • Directory Block: Address
  • Directory Block: Cell Phone
  • Directory Block: Home Phone
• Gradebook Notification Preferences*
  Please select your gradebook notification preferences for this parent/guardian.
  • Weekly: Auto Email Gradebook
  • Daily: Auto Email Gradebook
  • Never: Auto Email Gradebook
• Parent/Guardian 4 Information*
  First Last
• Date of Birth*
  MM slash DD slash YYYY
• Role*
  Please select one role listed below.
  • Mother
  • Father
  • Step Mother
  • Step Father
  • Legal Guardian 1
  • Legal Guardian 2
• Email*
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell Phone*
• Home Phone*
• Work Phone*
• Address*
  Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Employer Name
  Please provide us with the name of this parent/guardian's employer.
• Communication Preferences*
  Please select your communication preferences for this parent/guardian.
  • No Emergency Alert
  • ALL Emergency Alert Options
  • Emergency Alert: Cell Phone
  • Emergency Alert: Home Phone
  • Emergency Alert: Work Phone
  • Emergency Alert: Text Notification
• Directory Preferences*
  Please select your school directory preferences for this parent/guardian.
  • Include Name, Address, and Phone Numbers
  • Directory Block: Name
  • Directory Block: Address
  • Directory Block: Cell Phone
  • Directory Block: Home Phone
• Gradebook Notification Preferences*
  Please select your gradebook notification preferences for this parent/guardian.
  • Weekly: Auto Email Gradebook
  • Daily: Auto Email Gradebook
  • Never: Auto Email Gradebook

• Student 1 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 2 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 3 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 4 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 5 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 6 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 7 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Student 8 Information*
  First Last
• Grade*
  Pre-K3Pre-K4Junior KindergartenKindergarten123456789101112
• Race/Ethnicity*
  Please choose the category(s) below that best describes your LCA student.
  African American or BlackAsian American or Pacific IslanderCaucasian or WhiteLatino/HispanicMiddle EasternMultiracialNative American or Alaskan NativeNot Wanting to Report
• Church
  Where does the student attends church?
• Middle School Extended Care Interest*
  Would you be interested in an extended care option for students in Grades 6-8? This program would be available until 6:00PM for an additional fee.
  Select Yes or NoYesNo

• Grandparent 1 Name*
  First Last
• Email*
• Phone*
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Grandparent 2 Name*
  First Last
• Email*
• Phone*
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Grandparent 3 Name*
  First Last
• Email*
• Phone*
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Grandparent 4 Name*
  First Last
• Phone*
• Email*
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

• Emergency Contact 1 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 2 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 3 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 4 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 5 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 6 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 7 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*
• Emergency Contact 8 Name*
  First Last
• Relationship to Student*
• Email
• Phone Numbers*
  Select the type of phone numbers you wish to provide.
  • Select All
  • Cell
  • Home
  • Work
• Cell*
• Home*
• Work*

• Future Eagles*
  Please list the names, current ages/grades, and the grades in which you intend to enroll these Future Eagles at LCA. A member of our Admissions Team will reach out to you once we have processed your survey submission.
• Alumni Name*
  Can you please provide the name and contact information below for the alumnus that we should contact regarding an update?
  First Last
• Alumni Email*
• Alumni Phone
• Alumni Update
  We would be most grateful if you provide us with a brief synopsis of the update details. Thank you!

• On a scale of 0 to 10, how likely are you to recommend LCA to a friend or colleague?*
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
• How can we improve your experience at LCA?
• Why would you recommend LCA to others? Why not?
• CAPTCHA