Student's Name
                                          First                 Middle                Last

                  Date of Birth

                       Gender: Male           Female

        Social Security No.

 Grade expected to enter    For school year 

                        Address

                                                     Street                                 City                               State                   Zip   

              Phone Number    
                                    _____________________________________________

              Please check box of parent with whom student resides

Father        What title format do you prefer? e.g.   Mr.     Dr.     Col.      etc.

                           Name
                                        First                     Middle                    Last

                        Address
                                                      Street                                 City                               State                    Zip   

                 Home Phone      Cell       e-mail

                      Employer    Business phone



Mother       What title do your prefer? e.g.   Miss.     Mrs.     Col.      etc.    

                           Name
                                        First                     Middle                    Last

                        Address
                                                      Street                                 City                               State                    Zip   

                 Home Phone      Cell       e-mail

                      Employer    Business phone


Siblings:          
               1. Date of birth

               2. Date of birth  

               3. Date of birth     

Marital Status           Single         Married          Widowed   

                                     Divorced      Separated      

School District of Residence
                                        

                 Do you request district bussing?  Yes         No

Education of Child

                Current School

                 Current Grade

What Church does Family Attend?

Please list the aspects of our school which appeal to you most in considering enrollment:

                                     

In making application for the admission of the above named child, we declare the following:

We have acquainted ourselves with the program and policies of the school and we will cooperate with the administrative, educational and financial policies of the school

We agree that our child/children may be held subject to the rules and regulations of Christian discipline as practiced by this school.

Father's Signature      Date


Mother's Signature     Date


                                       

Further requirements

Health Records
A copy of immunization records is required.
Kindergarten students must show birth certificate.
All students on original entry (Kindergarten and students new to Pennsylvania) must have an examination and
    submit completed Private Physician's Report.
All 6th graders just have an examination and complete Private Physician's Report.
All students entering grades 1, 3, and 7 must have a dental exam and submit a Dentist Report.

Fees
A one time $100.00 registration fee per family is required.
Ten tuition payments are due the fifteenth day of each month from August through May.
$100.00 technology fee per child per child per year (for grades 1-8).
If the entire year's tuition is paid by August 1st, a 2% discount is applied.
$50.00 Sports Fee per student per sport per year.

                                      _____________________________________________

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