Legacy of Grace Interest Form

Thank you for your interest in joining Legacy of Grace. We are excited to learn more about you. Please complete this form with a parent or guardian.

Student Information

Student Full Name *

Preferred Name (if different)

Birthday*

Month

Day

Year

Current Grade (2025-2026 school year)*

9th

10th

11th

12th

School Name*

Student Cell Number*

Student Email (not school email)*

Address*

About You

Why are you interest in joining Legacy of Grace?*

What are your hobbies, talents, or interests?*

Are you currently involved in any extracurricular activities?*

Yes

If yes, please list

What are two personal goals you have for this school year?*

Is there anything you would like us to know about you?*

Parent/ Guardian Information

Parent/ Guardian Full Name*

Relationship to Student*

Parent/ Guardian Phone Number*

Parent/ Guardian Email*

Preferred Method of Communication*

Call

Text

Emergency Contact (if different from parent/ guardian above)

Parent/ Guardian Acknowledgment

I understand that my daughter is expressing interest in joining Legacy of Grace, and I consent to being contacted with additional information about the program.

Parent/ Guardian Signature*

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Date*

Month

Day

Year

Availability

What days are generally best for meetings?*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Preferred Time*

After School

Early Evening

Weekend

If selected, you will receive additional details regarding orientation and program expectations. We look forward to building a Legacy of Grace together!