NBCCS Enrollment Application

Enrollment Application (Grades K4-8th) 2025-2026

Developing well-rounded, lifetime Christian Warriors.
New Bloomfied Community Christian School

Developing well-rounded, lifetime Christian Warriors

NBCCS- PO Box 75, New Bloomfield, MO 65063

8377 Blessing Lane, New Bloomfield, MO 65063

(573) 491-0120 www.nbccs.net
Applying for Grade:*
Student Information
First Name*
Middle Initial*
Last Name*
Transferring from:
Name of School
Gender*

FemaleMale
Birth Date*

MonthDayYear
Home Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Church We Attend*
Name of Church
Pastor's Name*
Student Lives With:

MotherFatherGrandfatherGrandmotherStepfatherStepmotherFoster ParentGuardianOther
Individual Needs- Please check if the student has experienced or been enrolled in any of the following:

Speech/LanguageADD (Attention Deficit Disorder)Behavioral/Emotional DisorderADHD (Attention Deficit Hyperactivity Disorder)Occupational/Physical TherapyOther Educational Or Behavioral Concerns
Parent/Guardian Information
Father's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Employer
Employer/Occupation
Church Attends
Name of Church
Mother's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Employer
Employer/Occupation
Church Attends
Name of Church
Students MUST BE potty trained to use the toilet, clean up after themselves, and wash their hands.

NBCCS admits students of any race, color, and national or ethnic origin.
Student Health
Food Allergies:
Please list all food allergies, if none please indicate "none".
Medicine Allergies:
List all allergies to medicine. If none, please indicate "none".
Other Allergies:
Environmental such as bee stings, pollen, etc.
Other Health Concerns:

AsthmaFrequent Ear InfectionsFrequent HeadachesEpilepsyNose BleedsOther:
Other
Media Consent: By enrolling at New Bloomfield Community Christian School, your consent to use photos and videos of your son or daughter. Please read and respond to the following if necessary: As a parent/guardian, I understand that any photo/video would be used solely to illistrate educational activities or publicize school programs. Only the first name will be used if a student's name is used. No student names will be paired with student photos without direct consent from guardians.
If you have a specific reason to remove this permission, please check here, and while we cannot guarantee that photos won't be used, we will do our best to avoid the use of your child in school-sponsored photo/video.*

Please remove permission. I do not want my child's photo being used.You have my permission to use my child's photos for educational activities and publicizing school programs.
Enrollment Agreement: I/We have prayerfully considered my/our child(ren) enrollment at New Bloomfield Community Christian School. I/We understand that all enrollments are for one year and are reviewed anually. I accept all legal responsibility for the prompt and complete payment of (a) registration & technology feed, (b) tuition payment, and willful and negligent damage to school property by my/our child(ren).

I/We realize that the administration makes the final decision concerning New Bloomfield Community Christian School enrollment. I/We will be notified of my/our child's acceptance by the administration.
If applying for K4, can your child use the restroom on their own?

YesNo
Signature of Father/Guardian:

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Father's Signature and Today's Date:
Signature of Mother/Guardian:

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Mother's Signature and Today's Date:
After recieving your application form. we will review it and contact you with the following steps to secure enrollment for your child(ren). The next steps include visiting the school and meeting the administrator. We look forward to partnering with you in your child's education.

To provide accurate planning to serve our students and families best, we require a non-refundable enrollment deposit for each student.
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Enrollment Application (Grades K4-8th) 2025-2026

Student Information

Parent/Guardian Information

Student Health