Application for Student Enrollment

Application for Student Enrollment

Please complete this application in it's entirety before submitting
Student Information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Last School Attended: (include last grade completed)*
Student's Shirt Size*

Y SMY MEDY LGY XLSMMEDLGXL
Family Information:
Father's Name*

First NameLast Name
Father's Employer (include phone)*
Mother's Name*

First NameLast Name
Mother's Employer (include phone)*
Marital Status:*

SingleMarriedWidowedDivorced
Religious Information
Has the Father made a profession of faith?*
Has the Mother made a profession of faith?*
Has the Student made a profession of faith?*
Medical Information:
Does the student have any medical conditions?*

YESNO
If yes, please explain
Does the student have any allergies?*

YESNO
If yes, please explain
Does the student take any medications?*

YESNO
If yes, please explain
Student's Primary Healthcare Provider*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Scholastic Information
Has the student ever been expelled, dismissed, suspended, or refused admission to another school?*

YESNO
If yes, please explain
Has the student ever had disciplinary difficulties?*

YESNO
If yes, please explain
Has the student have learning difficulties?*

YESNO
If yes, please explain
Please indicate the academic level of the student's previous work*

ExcellentGoodAveragePoor
General Information:
• Application packet must be filled out completely before it can be processed
• Registration Fee of $300 must accompany application and is non-refundable
• An interview with the Parents, Child, and Administration will be required before final acceptance.
Signature*
Should be Empty:

Application for Student Enrollment

Student Information:

Family Information:

Religious Information

Medical Information:

Scholastic Information