Student Application
Application Date: ______
Student Information
Student’s Full Name ______Grade entering Fall ______
Age ______Birthdate ______Sex ______Social Security Number ______
Physical Address ______
Mailing address (if different than above) ______
Home Phone (_____)______Cell Phone (_____)______
1. Please describe how you perceive your child’s spiritual life: ______
______
______
2. Has your child to your knowledge been involved with alcohol, drugs, tobacco, cheating, stealing or sexual immorality? ______
______
3. Are there any unusual factors in your child’s life and/or home situation? ( ) Yes ( )No
If yes, please explain: ______
4. Describe your child’s strengths: ______
______
5. Describe your child’s weaknesses: ______
______
If you would rather describe any of the above during a personal interview, please indicate below:
( ) Yes, I would rather meet concerning question number(s) ______
School History
If your child has ONLY attended NHCS, check here _____
Previous Schools Attended:
School Name City/State Phone Grades Attended Year
______
______
______
______
Please give full details to any “yes” answer below or on a separate sheet of paper, including the principal’s name, date of the incident, the school, and the grade in which the incident occurred.
1. Has your child ever repeated a grade? ( ) Yes ( )No If yes, what grade? ______
2. Has your child ever received a detention? ( ) Yes ( )No
If yes, please explain: ______
______
3. Has your child ever been suspended or expelled from any school? ( ) Yes ( )No
If yes, please explain: ______
______
4. Has your child ever been enrolled or recommended for any of the following special classes?
( ) Gifted/Talented ( ) Learning Disability ( ) Speech ( ) Discipline
5. Does your child currently have an IEP? ( ) Yes ( )No
6. Has your child ever been evaluated for a learning disability or has your child ever had an IEP in the past? ( ) Yes ( )No
Medical Information
1. Does your child have any health conditions? ( ) Yes ( )No
If yes, please explain: ______
______
2. Does your child have any physical handicaps or other conditions that might affect his or her schoolwork, including physical education? ( ) Yes ( )No
If yes, please explain: ______
______
3. Does your child have any evidence of hearing or vision difficulties? ( ) Yes ( )No
If yes, please explain: ______
______
4. Does your child currently take prescription medications? ( ) Yes ( )No
If yes, please explain: ______
______
5. Will this be administered during school hours? ( ) Yes ( )No
6. Has your child ever been diagnosed with any physical/physiological or medical “condition” (i.e. ADHD, Autism, PDD, etc. ( ) Yes ( )No
If yes, please explain: ______
______
Parent Information
Parent / Guardian #1: ______Relationship ______
Physical Address ______
Mailing address (if different than above) ______
Home Phone (_____)______Cell Phone (_____)______
Email Address ______
Occupation ______Employer ______
Work Address ______
Work Phone (_____)______
Parent / Guardian #2: ______Relationship ______
Physical Address ______
Mailing address (if different than above) ______
Home Phone (_____)______Cell Phone (_____)______
Email Address ______
Occupation ______Employer ______
Work Address ______
Work Phone (_____)______
Marital Status of Parents: ( ) Married ( ) Widowed ( ) Separated ( ) Divorced ( ) Single
If widowed or divorced, is either parent remarried? ( ) yes ( ) no
If parents are divorced or separated, who has legal custody of the child? ______
Please list parenting schedule______
Is either parent forbidden by court order from having equal access to the child or the school records?
( ) yes ( ) no (please attach copies of legal documents stating such)
Please list all persons living in the home with the child and their relationship to the child:
Name Relationship______
______
______
______
______
Are you financially able to meet the monthly tuition requirement? ( ) yes ( ) no
Comments: ______
______
What do you see as part of your child’s education? ______
______
______
How did you learn about our school? ______
______
Why would you like your child to attend NHCS? ______
______
______
Church Information and Christian Walk
Please describe your (parent/guardian) walk with the Lord at this present time: ______
______
______
______
______
______
______
Do you attend church? ( ) yes ( ) no If so, what church? ______
Please list your Pastor’s name: ______Phone # ______
Please list your child’s youth Pastor/Leader______Phone # ______
How long have you attended your current church? ______
Please describe your current involvement in church, including volunteer experiences: ______
______
______
______
What services/Bible studies do you attend? ______
How often do you attend services/Bible studies? ______
Please give your (parent/guardian) personal testimony of your relationship with Jesus Christ and when you asked Him to be your Lord and Savior. Attach an additional sheet of paper if necessary.
Parent / Guardian #1 ______
______
______
______
______
______
______
Parent / Guardian #2 ______
______
______
______
______
______
______
Parent Signatures
It is my intent to enroll my child in New Horizon Christian School and in submitting this application, comply with the standards, policies, and procedures set forth in the Parent/Student Handbook. It is understood that this is an application only and does not guarantee enrollment into NHCS.
I certify that the information is complete and accurate. I understand that any information found to be inaccurate may be considered grounds for denial of admission or dismissal from this school.
Signature of Parent / Guardian #1 ______Date ______
Signature of Parent / Guardian #2 ______Date ______
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