NEW STUDENT ENROLLMENT APPLICATION

NEW STUDENT ENROLLMENT APPLICATION
Grace Christian School

A Ministry of Grace Gospel Church

1111 Adams Avenue, P. 0. Box 9128, Huntington, WV 25704

Phone: (304) 522-8635 Fax: (304) 522-3240
STUDENT'S LEGAL NAME
DATE
ENTERING GRADE
HOME PHONE
BIRTHDATE

MonthDayYear
BIRTHDATE

MALEFEMALE

Student's Father's Information
FATHER'S NAME
FATHER'S EMPLOYER
FATHER'S OCCUPATION
FATHER'S WORK PHONE
FATHER'S CELL PHONE
FATHER'S E-MAIL ADDRESS
example@example.com

Student's Mother's Information
MOTHER'S NAME
MOTHER'S EMPLOYER
MOTHER'S OCCUPATION
MOTHER'S WORK PHONE
MOTHER'S CELL PHONE
MOTHER'S E-MAIL ADDRESS
example@example.com

PARENT'S MARITAL STATUS
PARENT'S MARITAL STATUS

MarriedSeparatedDivorcedWidowedRemarriedOther

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Student Info
BILLING ADDRESS (if different than home address)
SCHOOL DISTRICT
• COUNTY
IN CASE OF EMERGENCY CALL
EMERGENCY CONTACT PHONE
PHYSICIAN
PHYSICIAN'S PHONE
PATERNAL GRANDPARENTS' NAME
PATERNAL GRANDPARENTS' ADDRESS
MATERNAL GRANDPARENTS' NAME
MATERNAL GRANDPARENTS' ADDRESS

Additional Children Info
IF YOU ARE ENROLLING A PRE-KINDERGARTEN STUDENT, PLEASE INDICATE THE FOLLOWING:
My child will be attending ________________.

HALF-DAYFULL-DAY

PLEASE LIST ANY BROTHERS OR SISTERS:

	NAME	AGE	M/F	NOT AT HOME?	SCHOOL	Grade
SIBLING 1
SIBLING 2
SIBLING 3

Student Health and Church Info
STUDENT HEALTH INFORMATION
CONDITION OF STUDENTS HEALTH
ARE THERE ANY DISABILITIES OR ALLERGIES?

YESNO
(If yes, please explain below)
CHURCH INFORMATION
CHURCH YOU NOW ATTEND
CHURCH ADDRESS
PASTOR'S NAME
CHURCH PHONE
ARE YOU MEMBERS?

YESNO
DOES THE FAMILY ATTEND SERVICES REGULARLY?

YESNO

Current or Previous School Info
CURRENT/PREVIOUS SCHOOL INFORMATION
LAST SCHOOL STUDENT ATTENDED
PRESENT GRADE
CURRENT/PREVIOUS SCHOOL ADDRESS
HAS THE STUDENT ATTENDED GRACE CHRISTIAN SCHOOL PREVIOUSLY?
HAS THE STUDENT EVER BEEN RETAINED? If yes, what grade or grades?
HAS THE STUDENT EVER BEEN EXPELLED FROM SCHOOL? If yes, please explain
SCHOLASTIC AVERAGE: Type the average letter grade for each subject below
ENGLISH
SCIENCE
MATH
HISTORY
EXTRA-CURRICULAR INTERESTS AND HOBBIES

Closing Info
WHY ARE YOU INTERESTED IN YOUR CHILD(REN) ATTENDING GRACE CHRISTIAN SCHOOL?
Non-Discriminatory Policy

Grace Christian School admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally afforded or made available to students at the school.
Should be Empty: