New Bloomfield Community Christian School
Developing well-rounded, lifetime Christian warriors
NBCCS-PO Box 75 New Bloomfield, MO 65063 573-491-0120 www.nbccs.net
Enrollment Application (Grades K4-9) 2026-2027
STUDENT INFORMATION:
Student's Name
First Name
Middle Initial
Last Name
Gender:
Male
Female
Birthday:
-
Month
-
Day
Year
Date
Applying for Grade:
Transfer from:
Name of School
Home mailing address
Address Details
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone #
Church Attends
Pastors Name
ADDITIONAL STUDENT INFORMATION
RESIDENCE:
Student lives with (primary residence)
Primary Residence
Father
Mother
Grandfather
Grandmother
Stepfather
Stepmother
Foster Parent
Guardian
Other
INDIVIDUAL NEEDS
Check if the student has experienced or been enrolled in any of the following:
Individual Needs Options
Speech/Language
ADD (attention deficit disorder)
Behavior/Emotional Disorder
ADHD (attention deficit hyperactivity disorder)
Occupational/Physical Therapy
Other education or health/behavior concerns:
Students MUST BE potty trained to use the toilet, clean up after themselves and wash their hands.
NBCCS admits students of any race, color, and national or ethnic origin
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STUDENT HEALTH
FOOD ALLERGIES: List all food allergies. If none, please indicate "NONE."
MEDICINE ALLERGIES: List all allergies to medicine. If none, please indicate "NONE."
OTHER ALLERGIES (environmental such as bee stings, pollen, etc.)
OTHER HEALTH CONCERNS Please check any of the following health conditions or concerns:
Asthma
Frequent ear infections
Frequent headaches
Epilepsy
Nose bleeds
Other
PARENT INFORMATION
FATHER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Cell Phone
Email
example@example.com
Employer/Occupation
Business Phone
Church Attends
MOTHER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Cell Phone
Email
example@example.com
Employer/Occupation
Business Phone
Church Attends
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Media Consent:
By enrolling at New Bloomfield Community Christian School, you consent to use photos and videos of your son or daughter. Please read and respond to the following if necessary: As a parent/guardian, I understand that any photo/video would be used solely to illustrate educational activities or publicize school programs. Only the first name will be used if a student's name is used. No student names will be paired with student photos without direct consent from guardians.
If you have a specific reason to remove this permission, please check here, and while we cannot guarantee that photos won't be used, we will do our best to avoid the use of your child in school-sponsored photo/video.
ENROLLMENT AGREEMENT:
I/We have prayerfully considered my/our child(ren) enrollment at New Bloomfield Community Christian School. I/We understand that all enrollments are for one year only and are reviewed annually. I accept all legal responsibility for the prompt and complete payment of (a) the registration & technology fees, (b) tuition payment, and any willful and negligent damage to school property by my/our child(ren).
I/We realize that the administration makes the final decision concerning New Bloomfield Community Christian School enrollment. I/We will be notified of my/our child's acceptance by the administration.
Signature of Father/Guardian:
Date:
-
Month
-
Day
Year
Date
Signature of Mother/Guardian:
Date:
-
Month
-
Day
Year
Date
After receiving your application form, we will review it and contact you with the following steps to secure enrollment for your child(ren). The next steps include visiting the school and meeting the administrator. We look forward to partnering with you in your child's education.
To provide accurate planning to serve our students and families best. We require a non-refundable enrollment deposit for each student.
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