2026-27 NEW STUDENT REGISTRATION FOR Elementary-Middle-High school

Shiloh Community School

204 W. Decatur St., Madison, NC 27025

shilohcommunityschoolllc@gmail.com

www.shilohcommunityschool.com

(336) 423-8482
2026-27 NEW STUDENT REGISTRATION FOR Elementary-Middle-High school

Please be prepared to pay your child's application fee of $75 at the end of this form.
- Student Full Name
  
  First NameMiddle NameLast Name
- Birth Date
  
  MonthDayYear
- Grade Entering
  for Incoming School Year '26-'27
- Gender of Student
  
  MaleFemale
- Father's/Guardian's Full Name
  
  First NameMiddle NameLast Name
- Father's/Guardian's Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Father's/Guardian's Cell Phone Number
  Format: (000) 000-0000.
- Father's/Guardian's Email
- Father's/Guardian's Home Phone Number
  Format: (000) 000-0000.
- Father's/Guardian's Employer
- Father's/Guardian's Work Phone Number
  Format: (000) 000-0000.
- Marital Status
- Mother's/Guardian's Full Name
  
  First NameMiddle NameLast Name
- Mother's/Guardian's Home Address (If not the same as the Father's/Other Guardian)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Mother's/Guardian's Cell Phone Number
  Format: (000) 000-0000.
- Mother's/Guardian's Email
  example@example.com
- Mother's/Guardian's Home Phone Number
  Format: (000) 000-0000.
- Mother's/Guardian's Employer
- Mother's/Guardian's Work Phone Number
  Format: (000) 000-0000.
- Marital Status
- What do you see as your child’s academic strengths?
  Be as detailed as possible.
- What do you see as your child’s academic weaknesses?
  Be as detailed as possible.
- Has your child ever been recommended for testing, tested and/or diagnosed for any of the following? Check all that apply. If any are checked, please explain the situation below by giving specific information.
  
  Attention Deficit DisorderSpeech/Language ImpairmentDyslexiaHearing ImpairmentHyperactivityVisual ImpairmentLearning DisabilityOther (Please Specify)
- Has your child been named a candidate for grade retention or summer remediation? If so, please explain and what grade they were in when this suggestion was made.
- List an explanation of the above condition(s):
- What does your child enjoy about school?
- What does your child dislike about school?
- Previous School Attended
- Year blanks to blank
- Previous School Attended
- Year blanks to blank
- Has your child been suspended or dismissed from any school? (If yes, please explain.)
- Has your child received special academic help (such as tutoring) or a modified curriculum plan? If so, please describe:
- Character Development
  
  Parents/Guardians, please respond to the following, giving us an idea of how you view your child. Check the applicable boxes using #1 as the weakest and #4 as the strongest.
- OBEDIENCE: responds willingly and immediately to requests by those in authority.
  
  1234
- RESPECTFULNESS: shows esteem and honor for God, others, self and towards property.
  
  1234
- SELF-CONTROL: keeps hands to self; controls talking, emotions and behaviors.
  
  1234
- RELIABLE: trustworthy and dependable in word and deed.
  
  1234
- DILIGENCE: makes a good effort, use of his/her time, completes tasks and gets work in on time.
  
  1234
- COURTEOUS: is polite, kind, gracious, patient, forgiving, and shares with others.
  
  1234
- ATTENTIVENESS: pays careful attention; listens fully to directions and follows them.
  
  1234
- NEATNESS: is clean, organized and cares for personal possessions, work and appearance.
  
  1234
- Please speak to your child's character and personality. List anything that we might need to know:
- Skills/Talents
  
  ActingArts/CraftsDancingDebatingDrawingFashionPhotographyPlaying drumsPlaying guitarPlaying pianoProgrammingSingingWritingMathReadingOthers (specify below)Hands-On/EngineerSTEM
- Sports
  
  BaseballBasketballCheerleadingFootballSoccerSoftballSwimmingTrack and FieldTennisVolleyballOthers (specify below)Horseback Riding
- Extra Curricular Participation
  
  Student CouncilClass OfficerClub/OrganizationSportsOthers (please specify below)4-HFFA
- Interests
- Our school emphasizes personal responsibility, respect, and ownership of actions. How do you reinforce these values at home?
- Describe how you view the partnership between parents and the school when challenges arise.
- When your child struggles academically, how do you support them at home (beyond simply completing homework), such as with studying, organization, or long-term projects? Please include examples such as study habits, project planning, accountability, communication with teachers, or use of outside support.
- What boundaries or expectations do you have around technology use at home?
- Our school believes that strong family relationships are foundational to student growth. How does this belief show up in your family life?
- Father's/Guardian's Testimony-Tell us about what being a believer means to you.
- Mother's/Guardian's Testimony-Tell us about what being a believer means to you.
- Does your family attend church?
  
  YesNo
- If so, tell us what church you attend and what your involvement is.
- If you’re new to SCS, how did you hear about us?
- In order of priority, please list and explain your reasons behind seeking admission for your child to attend Shiloh Community School:
- Have you applied for the NCSEAA Opportunity Scholarship?
  
  YesNo
- Have you applied for the NCSEAA ESA+ Scholarship?
  
  YesNo
- Is your child's enrollment contingent upon receiving the scholarship?
  
  YesNo
- Thank you for your interest in Shiloh Community School. After completing this application, please go back to the Enrollment Tab on our website and make your Registration Fee payment of $75. We look forward to speaking with you. We're praying for your family.
  
  Laura Easter & Ashley Ashby, SCS Leadership
- Should be Empty:

2026-27 NEW STUDENT REGISTRATION FOR Elementary-Middle-High school

Character Development

Thank you for your interest in Shiloh Community School. After completing this application, please go back to the Enrollment Tab on our website and make your Registration Fee payment of $75. We look forward to speaking with you. We're praying for your family.