Application Form

Application Form

The Waldorf School of Bend admits students of any race, color, national and 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 and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and others school administered programs.
If you have a coupon code, please fill out this application for Grades and for Early Childhood and email it to the office at: info@bendwaldorf.com
School year applying for:*
Please leave your email to receive a reminder once the application process opens for the Year 2025/2026 (September 4th, 2024)*
example@example.com
Requested date of entry:*

MonthDayYear
Date
Student
Student's Full Legal Name:*

First NameLast Name
Do you need the date of entry to be as soon as possible:*

YesNo
Student's Preferred Name
Student's Date of Birth*

MonthDayYear
Date
Gender*
Grade Applying for*
What days*

3 Day Program (Monday, Tuesday, Wednesday)
How long*

Half Day (8:30am to 1:00pm)Full Day (8:30am to 3:30pm)
How long*

Half Day (8:30am to 01:00pm)Full Day (8:30am to 3:30pm)
Are you planning to use your ERDC to pay for all or a portion of your tuition? (More information on ERDC here: https://www.oregon.gov/delc/programs/pages/erdc.aspx?utm_source=DELC&utm_medium=egov_redirect&utm_campaign=https%3A%2F%2Fwww.oregon.gov%2Fdelc%2Ferdc)*

YesNo
Parent/Guardian 1
Full Name*

First NameLast Name
Cell Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expertise*
A back-up phone number if cell phone is not available (landline, work phone etc.)*
Email*
example@example.com
Add Parent/Guardian 2?

Yes
Parent/Guardian 2
Full Name*

First NameLast Name
Cell Phone*
Address (if different from above)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expertise*
A back-up phone number if cell phone is not available (landline, work phone etc.)*
Email*
example@example.com
How long have you lived in the area?*
Full years only
How did you hear about the Waldorf School of Bend?*
If you have been referred by a parent at the Waldorf School of Bend, please share their name:
How familiar are you with Waldorf education?*
How long do you expect your child to be at the Waldorf School of Bend?*
Years only
Why have you brought your child to the Waldorf School of Bend? Would you like to see your child receive from his/her school experience?*
Family Relationships
With whom does the student live? (Name and relationship; describe the student's daily living arrangement.)*
Siblings (name, age, grade, and school)*
Add other adults residing in the home that your student resides in (Please explain)*
School/Academic History
Schools attended (including WSB)*
Name of the most recent teacher:*
Phone*
Subject(s) most enjoyed:*
Subject(s) least enjoyed:*
Academic strengths:*
Academic challenges:*
Activities outside of school (hobbies, sports, classes, other):*
Describe social behavior with peers:*
Artistic interests or talents:*
Does your child have any learning challenges that you are aware of?*

YesNo
Please describe:*
Is there any family history of learning challenges?*

YesNo
Please describe:*
Do you have any questions regarding the Waldorf curriculum or the Waldorf School of Bend?*
Is there a custody arrangement or court order in force regarding this child?*

YesNo
Health Profile and Home Life

Events in children's earliest years can have both subtle and profound effects on their later life. While some of the following questions may not seem to apply to your child's current situation, they are designed to bring parents and teachers together in forming the broadest possible picture of your child's development and daily life. We understand that this information is of a personal nature and appreciate your understanding in providing what you can to better help us assess your child's needs and how they can be met by our school.
How was the pregnancy? The birth? Was the baby delivered by Caesarean Section?*
Were there any special conditions or health concerns at birth for mother or baby?*

YesNo
Please describe*
Was your child adopted?*

YesNo
At what age?*
Does your child know?*

YesNo
When did your child begin crawling?*
Was there anything unusual in his/her crawl?*
When did your child begin to walk?*
When did your child begin to talk?*
Were there any challenges during early childhood with the eyes, ears, speech, coordination, skin, digestion? Please be specific:*
Please indicate the illnesses your child has had and at what age.
Chicken pox*
Whooping cough*
Ear infections*
Scarlet fever*
Seizures*
Measles*
Other
Has your child had any serious injuries, accidents, or surgery?*

YesNo
Please describe briefly:*
Was there any early psychological trauma your child experienced?*

YesNo
Please describe:*
Has your child ever undergone psychological, developmental, or educational testing or treatment?*

YesNo
Where?*
Please describe:*
Has your child had a vision exam?*

YesNo
When and where?*
Does your child wear glasses?*

YesNo
For what condition?*
Does your child have allergies?*

YesNo
Please describe*
Is your child on any medication?*

YesNo
For what condition?*
Has your child received care from a dentist?*

YesNo
Are there any current health concerns?*

YesNo
Please describe*
Does your child have any special needs?*

YesNo
Please describe*
Does your child have any fears?*

YesNo
Please describe*
What time is your child's betime on weekdays?*

Hour Minutes

AM/PM Option
What time is your child's betime on weekends?*

Hour Minutes

AM/PM Option
Does your child have any trouble falling asleep?*
Does your child sleep in his/her own bed?*
Does your child sleep in his/her own bed all night?*
Does your child wet the bed?*
What kind of activities does your family enjoy together?*
How regular or rhythmic is your child's home life? (meals, bedtime, story time, chores, baths, etc.)*
What meals do you share as a family?*
Any special diet?*
Describe your child's relationship with their sibling(s) (if applicable)
Describe what you do when your child does not meet your standard of behavior*
What language(s) is/are spoken at home?*
What kind of music do you and your child listen to at home?*
Does your child use a computer or video games?*

YesNo
How often?*
For how long?*
Does your child watch television or videos?*

YesNo
When?*
How often and for how long?*
If age-appropriate alternatives were suggested, would you have any difficulty limiting or eliminating television and video viewing, movie-going, video game playing or computer time for your child? Please explain your answer:*
Which hand does your child use for drawing or writing?*
In a paragraph, please try to give a picture of your child: his or her interests, strengths, challenges, tendencies, outstanding characteristics, etc.*
The Waldorf School of Bend has permission to contact {studentsFull}'s previous schools, teachers, physicians and counselors.
Who will sign the enrollment contract (tuition agreement) and be responsible for the payment of tuition and fees?
Name*

First NameLast Name
Address (if not parent):*
Name

First NameLast Name
Address (if not parent):
All the information will be kept confidential.

I understand that:
- All financial arrangements for tuition payments will be made through the Business Office
- The $65 application fee is due with application and is non-refundable
- This application is valid only for the year noted.
Signature of Parent or Guardian*

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Date*

MonthDayYear

Admission Application Fee*

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Application Form

Student

Parent/Guardian 1

Parent/Guardian 2

Family Relationships

School/Academic History

Health Profile and Home Life