Clone of 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 returning STUDENT REGISTRATION FOR Elementary-Middle-High school

Basic Information
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
Father's/Guardian's Email
Father's/Guardian's Home Phone Number
Father's/Guardian's Employer
Father's/Guardian's Work Phone Number
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
Mother's/Guardian's Email
example@example.com
Mother's/Guardian's Home Phone Number
Mother's/Guardian's Employer
Mother's/Guardian's Work Phone Number
Marital Status

Academic Background
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:

Shiloh Community School partners with families who value presence, healthy boundaries, accountability, and character development. The following questions help us ensure a strong home–school partnership.
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. As always, we value your support and belief in what God is building here, so thank you for partnering with us to continue the work He's set out for us. We're praying for your family.

Laura Easter & Ashley Ashby, SCS Leadership
Should be Empty:

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

Character Development

Thank you for your interest in Shiloh Community School. As always, we value your support and belief in what God is building here, so thank you for partnering with us to continue the work He's set out for us. We're praying for your family.