RHEMA STUDENT APPLICATION

RHEMA STUDENT APPLICATION

Rhema Christian School
GENERAL INFORMATION

Please fill out completely
Payment Plan Choice (1st payment of all plans is due June 1st before school starts.)*

Full Payment (June 1st)Semiannual (June 1st & December 1st)10 Monthly Payments (June 1st-March 1st)12 Monthly Payments (June 1st-May 1st)
Application Type*

New Student applicationSibling Application
I DO NOT give permission for information to be printed in the school directory.

(Optional) Do not include our information in the school directory
Gender of Student applying*

MaleFemale
Applying for Grade*
STUDENT INFORMATION

Please fill out information about the student applying.
Last Name*
First Name*
Middle Name
Preferred Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone (May be a cell)*
Please enter a valid phone number.
Parent or Guardian Email Address*
example@example.com
Birthday*

MonthDayYear
Date
Social Security Number*
School last attended
Preschool
Days a week attended
EMERGENCY MEDICAL INFORMATION

Please fill out completely
Name of Emergency Contact other than parents*
Phone/Cell #1*
Phone/Cell #2
Emergency Contact Relation to the Student applying*

FriendGuardianNon-Relative (other)Relative: If relative, please use input field below to type relation type. (example: Grand-Parent)
Applicants Doctor*
Doctor Phone*
Hospital Preference
PARENT/GUARDIAN AND FAMILY INFORMATION
Father Marital Status*

MarriedWidowerSeparatedDivorcedRemarriedOther
Mother Marital Status*

MarriedWidowSeparatedDivorcedRemarriedOther
Fathers Name
Mothers Name
Father Address
Mother Address (If different from Father's)
Father City
Father State
Father Zip
Mother City (If different.)
Mother State (If different.)
Mother Zip (If different.)
Father Employer's Name
Mother Employer's Name
Father Job Title
Father Occupation
Mother Job Title
Mother Occupation
Father Work Phone
Mother Work Phone
Father Home Phone
Mother Home Phone (If different.)
Father Cell Phone
Mother Cell Phone
Father Work Email
example@example.com
Mother Work Email
example@example.com
Father Number of Years in High School
Father Number of Years in College
Mother Number of Years in High School
Mother Number of Years in High College
Check all that apply for the Father

Lives with StudentReceives mailRecieves bill
Check all that apply for the Mother

Lives with StudentReceives mailRecieves bill
In the event of sole primary custody, the school requires copies of the custodial legal documents to be provided to the Admissions Office at the time of application.
If parents are separated or divorced who has legal custody
GRANDPARENT INFORMATION
Paternal Grandparent Names
Paternal Grandparents Address (If applicable.)

Address

Street Address Line 2

CityState

Zip
Paternal Grandparent Phone Number
Please enter a valid phone number.
Maternal Grandparent Names
Maternal Grandparents Address (If applicable.)

Address

Street Address Line 2

CityState

Zip
Maternal Grandparents Phone
OTHER CHILDREN INFORMATION (IF APPLICABLE)
How Many School Age Children are in your household?

1234
Child #1 Name
Child #2 Name
Child #3 Name
Child #4 Name
Child #1 Age
Child #2 Age
Child #3 Age
Child #4 Age
Child #1 Grade
Child #2 Grade
Child #3 Grade
Child #4 Grade
Child #1 School
Child #2 School
Child #3 School
Child #4 School
What church do you attend*
Are you a member
For how long*
How often does the Father attend church?*

RegularlyOccasionallyRarely
How often does the Mother attend church?*

RegularlyOccasionallyRarely
How often does the Student attend church?*

RegularlyOccasionallyRarely
PARENT/GUARDIAN QUESTIONNAIRE & COMMITMENT
"Through differentiated learning strategies and a Biblical, Spirit-led approach, we help children discover their identity in Christ and their love of learning; therefore building them up as disciples of Jesus Christ."
Do you understand and agree with the above Mission Statement of RCS?*

YesNo
Will one parent attend Parent-Teacher Fellowships?*

YesNo
PARENT QUESTIONNAIRE & COMMITMENT
1. How did you hear about RCS?*
2. Considering the goals for your student, why would you like your student(s) to attend RCS?*
3. Has the student ever been referred to a resource teacher? If yes, please provide date and reasons for referral.*
4. Has the student ever had modifications made to the classroom?*
5. Has the student ever been administered psychological, behavioral, or academic testing to determine if he/she is gifted, has a learning disability, ADD, ADHD, behavioral, neurological, sensory, or emotional disorder? If yes, please provide dates, test results, evaluations, IEP reports, etc. This information is not routinely part of the cumulative folders and must be requested by the parent/guardian from the resource teacher or school counselor.*
6. Is the student presently taking any medication for medical or learning problems? If yes, please provide kind of medication, dosage,and frequency. Please provide a copy of a medical evaluation, which must be within the last twelve months.*
7. Does your child have any allergies? Please list all.*
8. Does your student have health problems? Please list all.*
9. Was your student a premature birth? If yes what was the term?*
10.a. Does your student have normal or corrected vision?*
10.b Does your student have normal hearing?*
11. Has your student ever been recommended for tutoring or remedial instruction? If yes, please explain.*
12. Has the student ever repeated a grade? If yes, which grade? Please explain.*
13. Has the student ever been suspended or dismissed from school? If yes, please explain.*
14. Has your child had disciplinary difficulty in his/her previous school?*
15.a. Is your child a ward of the court?*
15.b. Has your child been under the jurisdiction of the court?*
15.c. Has your child committed a felony*
16. Is there any additional information that Rhema Christian School should be aware of when considering this student for enrollment?*
17. What activities or responsibilities are you and your student(s) involved in at your church?*
18. Please describe prayer time and Bible study in your home.*
19.a. Please give a brief statement summarizing your beliefs as it relates to Jesus Christ.*
19.b. Please give a brief statement summarizing your beliefs as it relates to the Bible.*
Father/Guardian #1 Signature*

Clear
Date*

MonthDayYear
Date
Mother/Guardian #2 Signature (If applicable)

Clear
Date

MonthDayYear
Date
Should be Empty:

RHEMA STUDENT APPLICATION

GENERAL INFORMATION

STUDENT INFORMATION

EMERGENCY MEDICAL INFORMATION

PARENT/GUARDIAN AND FAMILY INFORMATION

PARENT/GUARDIAN QUESTIONNAIRE & COMMITMENT

PARENT QUESTIONNAIRE & COMMITMENT