APPLICATION FOR ENROLLMENT AT HERITAGESCHOOL
Please mail to PO Box 2065, Salem, OR 97308, or email to
You may either fill out this application and return it via email (type responses in shaded fields) or print a copy and send it to our school’s PO box.
Student’s name ______Age Birth date
Current school______Current grade
Previous schools ______
Mother’s name ______
Mother’s address ______Zip __
Mother’s home # ______Cell #______
Mother’s work # ______Employer______
Father’s name ______
Father’s address ______Zip __
Father’s home # ______Cell#______
Father’s work # ____Employer______
Email addresses ______
Names and ages of my child’s siblings ______
Date of this application ______
I am interested in enrolling my child at HeritageSchool for the 2014-15 school year. Please contact me if there is an opening in my child’s age group.
I am interested in exploring enrollment at HeritageSchool for the
2015-2016 school year
2016-2017 school year
2017-2018 school year
Other (please specify) ______
I have already visited the HeritageSchool and observed the program during
the school day.
I would like to schedule an appointment to visit Heritage while school is in
session.
I would like to schedule an appointment for my child to visit HeritageSchool.
Who recommended HeritageSchool to you? ______
______
Heritage School includes students from grades one through eight. If your child enrolls at Heritage, through which grade do you think he or she would remain in our program? ______
Occasionally we find it helpful to speak with teachers who’ve taught your child in the past. If you are willing to give us permission to contact teachers or others (counselors, friends, etc.) who might be able to help us know your child better, please list their names, relationships to your child, and their phone numbers. Please let the people listed below know that you have given them permission to share relevant information with us about your child. Note: we do not require letters of recommendation.
______
______
______
You may answer the following questions in the space below, or you may attach separate pages.
Why are you interested in sending your child to HeritageSchool?
What might be helpful for us to know about your child if we become his or her teachers? For example, you might tell us about your child’s temperament, social interactions with peers, special interests, learning style, your goals for your child, your child’s strengths, areas of need, and so on.