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Request Information

Thank you for your interest in Bethany Christian Academy!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us? *
    Details:

  • Will you be able to attend our Open House for Prospective Preschool Parents on Monday, March 25th at 6:00 pm? 

  • Will you be able to attend our Open House for Prospective K-12 Parents on Monday, March 25th from 6:30-8:00 pm?
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Student Interests
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •