Online Admission Application

Child's Legal Name

First Name

Last Name

Child's Age

Sex

Male

Female

Ethnicity

Grade to Enroll in

Last School Attended

Has your child repeated any grade?

Do you attend church regularly?

Does your child have any physical limitations, which might require some adjustments to a normal student schedule?

Does your child have a learning disability or limitation that might require special professional assistance?

Does your child take prescription medication regularly?

Does your child have a confidential file at his or her previous school?

Has your child ever been evaluated for an Individualized Education Program (IEP)?

Has your child been hospitalized within the past year?

Has your child been treated for any nervous, mental, or emotional disorder?

Has your child been suspended?

Do you owe a balance at your child's previous school?

Grade Average of Last Report Card

For Grades 3rd and above

Are you a parent or guardian?

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country