Please complete this application to re-enroll for next year. To pay the $800 tuition deposit online, click here.  If you prefer to pay in the school office, we accept VISA, MasterCard, or check, payable to "Rockbridge Academy."

Student Information:
Student's Full Name:
Nickname:
Mailing Address:
City:
State:
Zip Code:
Phone:
Date of Birth:
Re-Enrolling for Grade:
Re-Enrolling for Year:
 
General Parent/Guardian Information:
Parents are: Married Divorced
Separated Single Parent
Mother Remarried Father Remarried
Mother Deceased Father Deceased
Send Admissions Office Correspondence to: Both Parents / Guardians listed
Other
 
Parent/Guardian 1:
Name:
Nickname:
Relationship to Student:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Home E-mail:
Work E-mail:
Place of Employment / Type of Business:
Occupation / Position:
 
Parent/Guardian 2:
Name:
Nickname:
Relationship to Student:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Home E-mail:
Work E-mail:
Place of Employment / Type of Business:
Occupation / Position:
 
Paternal Grandparent(s)
Name(s):
Address:
City:
State:
Zip Code:
Home Phone:
E-mail:
 
Maternal Grandparent(s)
Name(s):
Address:
City:
State:
Zip Code:
Home Phone:
E-mail:
 
Church Information
Church Attending:
Members of Church?
Address:
City:
State:
Zip Code:
Phone:
Pastor:
 
Financial Information
Billing Name:
Billing Address:
Billing State:
Billing Zip Code:
 

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I have read the Parent/Student Handbook and agree to abide by the school policies and guidelines as stated in the handbook. Agree Disagree
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Rockbridge Academy Inc. admits students of any race color, national, or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational policies, admission policies, scholarship, and/or loan programs, athletic, and other school-administered programs.
   

 


 
 
911 Generals Hwy, Millersville, MD 21108 - P: 410-923-1171 - learning@rockbridge.org