GCS-Enrollment-Application-Form

Grace Community Schools

Enrollment Application Form
Choose A Location:
Location:*
Child's Information:
Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Social Security Number:
Mother's Information:
Name:

First NameLast Name
Date of Birth:

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Area CodePhone Number
Work Number:

Area CodePhone Number
Social Security Number:
E-mail:
Father's Information:
Name:

First NameLast Name
Date of Birth:

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Area CodePhone Number
Work Number:

Area CodePhone Number
Social Security Number:
E-mail:
Emergency Contacts/Persons permitted to pick up:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permitted Pick Up:

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Are there any special instructions concerning your child? Do they have any allergies?
How did you hear about us?

InternetDirect MailPhone BookFriendOther
Referred By?
Parental Agreement:
I hereby give my consent to have my child treated by a physician for medical or surgical care should an emergency arise. I understand that every effort will be made to contact me or a relative before such action is taken. I agree to pay the amount due in advance, on a weekly basis, for the time my child is enrolled. I understand that I may withdraw at any time by notifying the school one week in advance. Withdraw is effective the Friday of the week of Notification, and all other fees are payable upon other absences. I have read the policies of Grace Community Schools, and agree to abide by the regulations set forth in them, Including the obligation to confer with the school first if I have any questions or problems.
I have read and agree to the GCS Parental Agreement.
Full Name*

First NameLast Name
Current Date:*

MonthDayYear
Should be Empty:

Grace Community Schools

Choose A Location:

Child's Information:

Mother's Information:

Father's Information:

Emergency Contacts/Persons permitted to pick up:

Parental Agreement: