Student Information

Name

First Name

Last Name

Birthdate

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Sex

Birthplace

School Last Attended

Last Grade Completed

Grade Applying for

Full or 1/2 Day

Our Pre-K and Kindergarten students have the option for full or half day classes. Please choose accordingly.

Father's Information

Father's Name

First Name

Last Name

Phone Number

Employment

Position

Mother's Information

Mother's Name

First Name

Last Name

Phone Number

Employment

Position

Family Information

Marital Status

If the parents are divorced or separated, who has custody of the student?

School age children in family NOT applying:

Please list: NAME AGE REASON FOR NOT APPLYING

Religious Information

Church Attending

Pastor

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church Phone Number

Is the Father a Christian?

Is the Mother a Christian?

Medical Information

Family Physician

Physician's Phone Number

Does the student have any allergies?

Explain

If you answered "yes" to the above question please list the student(s) and their allergies.

* You must submit a medical history form which can be found under "News & Info", with a record of immunizations for each child before enrollment*

Scholastic Information

Has the student ever been expelled, dismissed, suspended, or refused admission to another school?

If "yes", please explain:

Has the student even been a consistent disciplinary problem at school?

If "yes" please explain:

Does the student have a juvenile or arrest record?

If "yes" please explain:

Has student ever used alcohol, tobacco, or non-prescription drugs of any kind?

If "yes" please describe the nature of items used and explain:

Please indicate the academic level of students' previous work

Has the student ever failed an academic subject in school?

If "yes" please explain:

Signatures

Please have the mother and father or legal guardians type their full name to acknowledge everything provided in this form is factual and both parties are aware of enrollment application.

Mother's Full Name

Father's Full Name