Central Kentucky Christian School
1501 Danville Rd., Harrodsburg, KY 40330
Phone 859-734-9347 Fax 859-734-9348
On the web ( www.ckcsonline.com )
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Student's Full Name
Age
Date of Birth
Gender
Male
Female
Grade/Fall
Previous School
Mother
Father
Legal Guardian
Relation
Current Address
City
State
Zip
Home Phone
Mother Cell
Father Cell
Other
Email
Please provided your pastor's name and the name and number of the church your family currently attendes.
Pastor/Minister
Phone Number
Church/Location
Member(s)?
Emergency contact and relation
Phone
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