Application

Company

This field is for validation purposes and should be left unchanged.

Date of Birth*

Entering Grade Level*

Place of Birth*

Email*

Phone Number*

Last school Attended*

Church Child attends

Denomination

Parent 1*

Email*

Phone Number*

Marital Status*

Relation to Child*

Parent 2

Email

Phone

Marital Status

Relation to Child

Person to notify in case of emergency*

Phone*

Physician to call in case of emergency*

Students will go to and from school*

If yes, please explain

* NOTE: Grade placement of transfer pupils is tentative until official transcripts and records are received from last school.

Last school attended

Phone

Date of last attendance

Grade Completed*

Student Signature*

Parent's or Guardian's Signature*

Date*

New Student Application