Seymour Community Christian School Student Application

  • Seymour Community Christian School

    Student Application Form

  • NOTE: It is understood that the school has a right to accept or reject a student , as it deems advisable. 

  • Student Information

  • Date of Birth *
     - -
  • Format: (000) 000-0000.

  • Previous School Information

    Please list each school the student has attended starting with the most recent.
  • Date Attended From
     - -
  • Date Attended To
     - -
  • Date Attended From
     - -
  • Date Attended To
     - -
  • Date Attended From
     - -
  • Date Attended To
     - -

  • Student Academic Information

  • Has the child ever been suspended or asked not to return to a school?*
  • Does the child have any learning difficulties?*
  • Has the child ever been tested or recommended to be tested for a learning disability or for ADD/ADHD?*
  • Does the student require modifications to meet academic requirements?*
  • Has the student ever participated in a special needs program (including gifted, resource, special ed.)?*
  • Has the student ever had an individualized education plan (IEP)?*

  • Church Affiliation      Attend Regularly?         
    Name of Pastor         
    Address                  
    Phone Number         

  • Statement of Faith

  • We believe in the verbal inspiration of the Bible, both the old and new testaments, the Trinity of the Godhead; the creation of man by the direct act of God; the fall of man and his need for redemption; the deity, incarnation and virgin birth of our Lord and Saviour Jesus Christ; His vicarious atonement for the sins of mankind by the shedding of His blood on the cross; the resurrection of His body from the tomb; His ascension into heaven; His personal, imminent return; the deity of the Holy Spirit; justification of the believer by grace through faith; a literal devil who is our adversary; a literal heaven for the redeemed and a literal hell for the lost; the infallible rule of interpretation of scripture to be scripture itself; and the requirement of implicit obedience to the commands of Christ as the standard by which He will judge our love to Him.

  • Do you fully subscribe to this Statement of Faith?*

  • Non-Discriminatory Policy

  • SCCS admits students of any race, color, national, or ethnic origin, sex, or handicap to all the rights, priveleges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national origin, sex, or handicap in administration of its educational policies, athletics, or other school administered programs. 

  • Agreement of Co-operation:

  •  Declaration by Parents/Guardian

    1. As the parent (or guardian) of the above applicant, I agree to co-operate with SEYMOUR COMMUNITY CHRISTIAN SCHOOL in the enforcement of the disciplinary rules and regulations of the institution and to meet the terms of the agreement about expenses and business details as outlined by the school.
    2. I also agree to give my permission for my child to go on field trips and school trips and will not hold the school or any person responsible in case of an accident. This includes all carpools as well as buses and vans. 
    3. Before a student can begin classes at SEYMOUR COMMUNITY CHRISTIAN SCHOOL, the following must be on file at the school: All application information, tuition contract, student transcripts, registration, book, and activity fees, and a complete Tennessee School Immunization Certificate. 
  • Date*
     - -
  • Should be Empty: