KINGSWAY PREPARATORY SCHOOL APPLICATION

KINGSWAY PREPARATORY SCHOOL

"But ye are a chosen generation, a royal priesthood, an holy nation, a peculiar people." 1 Peter 2:9
Student Information
Incoming Grade Level*
Date of Birth*

MonthDayYear
Student Name (First and Middle)*
Student Name (Last)*
Race/Ethnicity*
Language(s) Spoken at Home*
Gender*
Gender
Home Phone*
Home Phone
Home Address*

Street Address Line 2

CityZip Code

Zip Code
School Last Attended*
Name/Address
School Phone Number*
Health History
Does your child have any health challenges (e.g., allergies, illnesses) or physical limitations (e.g., vision, hearing)?*
Please list any health challenges or physical limitations here.
Does your child have any learning challenges (e.g., ADD, ADHD, learning/developmental concerns, etc.)?*
Please list any learning or developmental challenges here.
Physician Information*
Name/Address
Physician Number*

Family Information
Parent/Guardian 1 *

First NameLast NameRelationship to Student
Address*

Street Address Line 2

CityZip Code

Zip Code
Email Address*
Phone Number*
Occupation*
Employer and Position
Work Number*
Parent/Guardian 2

First NameLast NameRelationship to Student
Home Address

Street Address Line 2

CityZip Code

Zip Code
Email Address
Phone Number
Occupation
Employer and Position
Work Number
Student lives with:*

FatherMotherBothOther
If other, please specify.
Other children in student's family:

NameAgeGender
Child 2

NameAgeGender
Child 3

NameAgeGender
Child 4

NameAgeGender

Why do you want your child to attend Kingsway?*
What phrases come to mind when describing your child?*
Please describe home handling of child behavior concerns.*
Is there anything else that you would like to share?
(e.g., Share things that might affect your child's learning and behavior; this could include family situations, or personal preferences that you believe are important for us to know. Your insights are valuable in helping us create a supportive and inclusive learning environment for your child.
How did you hear about Kingsway? Select up to four options.*

Internet SearchFacebookInstagramWebsiteFriend or RelativeChurchFlyerKingsway ParentOther
Other (If a Kingsway parent referred you, please name here)
Emergency Information
In case of emergency, who should be notified? Please list at least two contacts.
Emergency Contact Person 1*

First Name Last Name
Relationship to Student*
Emergency Phone Number*
Please enter a valid phone number.
Emergency Contact Person 2*

First Name Last Name
Relationship to Student*
Emergency Phone Number*
Please enter a valid phone number.
Emergency Contact Person 3

First Name Last Name
Relationship to Student
Emergency Phone Number
Please enter a valid phone number.
Religious Affiliation
Please describe your family's church affiliation/involvement.*
Church Information

Name of ChurchPastor's NameYears of Membership
Reminders
APPLICATION FEE: The non-refundable $75 application fee must be submitted via electronic check or Zelle (to kingswayprep@gmail.com) before the application is processed.

RECORDS: Upon admission, students must provide a copy of their birth certificate, immunization, dental, and health records, and other documents deemed necessary for enrollment.

DISCLAIMER: Admission to Kingsway is open to all applicants regardless of race, color, or national origin. However, applicants must understand and respect the Christian values and principles upheld by the institution.
Name*

First NameLast Name
Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

Clear
Should be Empty:

KINGSWAY PREPARATORY SCHOOL

Student Information

Health History

Family Information

Emergency Information

Religious Affiliation

Reminders