* Required

2021-22 Back-to-School Form

Please fill out this form for all of your students. This form is required for the 2021-22 school year and must be completed by July 28, 2021.

PLEASE NOTE: This form is easiest to complete while on a computer, not a phone. You must complete the form in one session, you cannot "save it for later."


Be sure you have all your necessary health forms ready to upload.

Parent Information

Select both parents unless you are a single parent.

Student #1 Information

Special Activities & Trip Permissions for Middle School

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Special Activities & Trip Permissions for Upper School

Seniors leave Sept. 19, Grades 9-11 leave Sept. 20. All upper school returns Sept. 22.​​​​​

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Student Drivers

If your answer is YES, please be sure to complete Vehicle Registration form after you have submitted the Back to School form.​​

Athletic Physical

Athletic physicals are required to participate in middle and upper school athletics.​ If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.​​​​​​​​​ If YES, please be sure to complete the online athletic physical form after you have submitted the back to school form.​​

Health Room

If you would like the nurse to administer any prescribed or over-the-counter medication during school hours (including overnight field trips), a medication authorization document SIGNED BY THE DOCTOR is required.

The medication name, dose and frequency must be included on the sheet that the DOCTOR SIGNS.


Max file size: 10 MB
Since you have indicated that this is a NEW STUDENT, you are required to have a doctor fill out and sign the "Immunization Record."​​​
Max file size: 10 MB

Since this student is in Kindergarten, grade 7 or grade 12, you are required to have a doctor fill out and sign the "Immunization Record."

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

Student #2 Information

Special Activities & Trip Permissions for Middle School

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Special Activities & Trip Permissions for Upper School

Seniors leave Sept. 19, Grades 9-11 leave Sept. 20. All upper school returns Sept. 22.​​​​

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Student Drivers

If your answer is YES, please be sure to complete Vehicle Registration form after you have submitted the Back to School form.​​

Athletic Physical

Athletic physicals are required to participate in middle and upper school athletics.​ If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.​​​​​​​​​ If YES, please be sure to complete the online athletic physical form after you have submitted the back to school form.​​

Health Room

If you would like the nurse to administer any prescribed or over-the-counter medication during school hours (including overnight field trips), a medication authorization document SIGNED BY THE DOCTOR is required.

The medication name, dose and frequency must be included on the sheet that the DOCTOR SIGNS.


Max file size: 10 MB
Since you have indicated that this is a NEW STUDENT, you are required to have a doctor fill out and sign the "Immunization Record."​​
Max file size: 10 MB

Since this student is in Kindergarten, grade 7 or grade 12, you are required to have a doctor fill out and sign the "Immunization Record."

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

Student #3 Information

Special Activities & Trip Permissions for Middle School

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Special Activities & Trip Permissions for Upper School

Seniors leave Sept. 19, Grades 9-11 leave Sept. 20. All upper school returns Sept. 22.​​​​

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Student Drivers

If your answer is YES, please be sure to complete Vehicle Registration form after you have submitted the Back to School form.​​

Athletic Physical

Athletic physicals are required to participate in middle and upper school athletics.​ If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.​​​​​​​​​ If YES, please be sure to complete the online athletic physical form after you have submitted the back to school form.​​

Health Room

If you would like the nurse to administer any prescribed or over-the-counter medication during school hours (including overnight field trips), a medication authorization document SIGNED BY THE DOCTOR is required.

The medication name, dose and frequency must be included on the sheet that the DOCTOR SIGNS.


Max file size: 10 MB
Since you have indicated that this is a NEW STUDENT, you are required to have a doctor fill out and sign the "Immunization Record."​​
Max file size: 10 MB

Since this student is in Kindergarten, grade 7 or grade 12, you are required to have a doctor fill out and sign the "Immunization Record."

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

Student #4 Information

Special Activities & Trip Permissions for Middle School

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Special Activities & Trip Permissions for Upper School

Seniors leave Sept. 19, Grades 9-11 leave Sept. 20. All upper school returns Sept. 22.​​​​

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Student Drivers

If your answer is YES, please be sure to complete Vehicle Registration form after you have submitted the Back to School form.​​

Athletic Physical

Athletic physicals are required to participate in middle and upper school athletics.​ If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.​​​​​​​​​ If YES, please be sure to complete the online athletic physical form after you have submitted the back to school form.​​

Health Room

If you would like the nurse to administer any prescribed or over-the-counter medication during school hours (including overnight field trips), a medication authorization document SIGNED BY THE DOCTOR is required.

The medication name, dose and frequency must be included on the sheet that the DOCTOR SIGNS.


Max file size: 10 MB
Since you have indicated that this is a NEW STUDENT, you are required to have a doctor fill out and sign the "Immunization Record."​​​
Max file size: 10 MB

Since this student is in Kindergarten, grade 7 or grade 12, you are required to have a doctor fill out and sign the "Immunization Record."

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

Student #5 Information

Special Activities & Trip Permissions for Middle School

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Special Activities & Trip Permissions for Upper School

Seniors leave Sept. 19, Grades 9-11 leave Sept. 20. All upper school returns Sept. 22.​​​​

YoungLife (owners of Windy Gap) require their own release form for your student to attend Windy Gap. Please complete the following YoungLife release:


Student Drivers

If your answer is YES, please be sure to complete Vehicle Registration form after you have submitted the Back to School form.​​

Athletic Physical

Athletic physicals are required to participate in middle and upper school athletics.​ If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.​​​​​​​​​ If YES, please be sure to complete the online athletic physical form after you have submitted the back to school form.​​

Health Room

If you would like the nurse to administer any prescribed or over-the-counter medication during school hours (including overnight field trips), a medication authorization document SIGNED BY THE DOCTOR is required.

The medication name, dose and frequency must be included on the sheet that the DOCTOR SIGNS.


Max file size: 10 MB
Since you have indicated that this is a NEW STUDENT, you are required to have a doctor fill out and sign the "Immunization Record."​​
Max file size: 10 MB

Since this student is in Kindergarten, grade 7 or grade 12, you are required to have a doctor fill out and sign the "Immunization Record."

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

Family Expectations Agreement

I/We the parent(s) or legal guardian(s) of the above named minor do hereby appoint a Charlotte Christian School representative to act on my/our behalf in authorizing unexpected medical, dental, surgical and/or hospitalization for the above named minor during our absence from 8/16/2021 - 8/16/2022. This document shall be presented to a physician, dentist or appropriate hospital representative at such time as an unexpected health issue occurs.

Digital Signature Acknowledgement - Type Name of Parent

Electronic Signature (eSignature): You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using any electronic form we offer; or in accessing or making any transactions regarding any document, agreement, acknowledgement, consent, term, disclosure, or condition constitutes your signature, acceptance and agreement as if actually signed by you in writing. Further, you agree that no certification authority or other third party verification is necessary to validate your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or resulting contract between you and Charlotte Christian School. You understand and agree that your eSignature executed in conjunction with the electronic submission of your form will be legally binding and such transaction will be considered authorized by you.

Thank you for your assistance and prompt attention to the information requested on this form. The parent/guardian set forth in this form does hereby agree to hold harmless the person appointed as well as Charlotte Christian School and the physician providing treatment from and against any and all loss, costs, damage or expense of any kind arising out of or in connection with that person’s or physician’s acting in reliance upon the authorization set forth herein, with the exception of actions which amount to gross negligence.