LCA Re-enrollment Form

NOTE: If you have not already, please contact Customer Service for tuition payment arrangements in addition to filling out this form.

If you have never registered with LCA previously, please fill out the LCA Online Registration Form for new students instead.

Family Information

Postal Code*:

Home Phone*:
Work Phone:

Cell Phone:
Email Address:

Parents/Guardians Names*:

Student Information (fill out at least one)
1) Student's Name*:

Birth Date*:
2) Student's Name:

Birth Date:

3) Student's Name:

Birth Date:
4) Student's Name:

Birth Date:

Please list other information regarding the student that may be of assistance to the LCA Advisor:

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* - Required Fields

Accelerated Christian Education Canada
P.O. Box 1360 
|  Portage la Prairie, MB 
|  R1N 3N9
Ph: (204) 428-5332 
|  TF: 1 (800) 976-7226

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All Rights Reserved
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