Enrollment Application
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Email *
Projected Year of High School Graduation *
Student Information
First Name of Student *
Middle Name of Student *
Last Name of Student *
Address *
City *
State *
Zip Code *
Household Phone Number
Gender *
Date of Birth *
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Student Cell Number
Parent and/or Legal Guardian Information
Who does the student live with? *
Father and/or Legal Guardian (First and Last Name) *
Address (if different from Student)
City
State
Zip Code
Father's Cell Phone
Father's Email Address
Father's Employer *
Telephone Number of Employer *
Parent and/or Legal Guardian Information
Mother and/or Legal Guardian (First and Last Name) *
Address (if different from Student)
City
State
Zip Code
Mother's Cell Phone
Mother's E-mail Address
Mother's Employer *
Telephone Number of Employer
Does your student have a Medical or Educational diagnosis that may affect his/her learning and/or testing? *
Does your student an Individualized Education Plan (IEP)? If so, please submit with Enrollment Application. *
Doctor's Information
Doctor's Name *
Doctor's Number *
Emergency Contact Information
Emergency Contact, if Parent can't be reached *
Best Number for Emergency Contact *
Relationship to Student *
School Information
What school did the student attend prior to the enrollment at The Lutheran High School of Kansas City? *
Telephone Number of School *
School District Student Resides In *
Church
Church Student Attends *
Ethnicity
Ethnicity information is used for school database research purposes only.
Please choose the option which best describes your child. *
Referral
How did you hear about The Lutheran High School of Kansas City *
Permissions
Please complete the questionnaire.
Upon request, The Lutheran High School of Kansas City provides contact information such as telephone numbers and address for the car pool program, Booster Club events, or other school related purposes. Do you give permission for your demographic information to be distributed for these purposes? *
I/We understand that photographs and/or video taken involving my/our child while he/she is a student at The Lutheran High School of Kansas City may be used for the publicity of The Lutheran High School of Kansas City. *
I/We understand that at times my/our student may have access to the internet.  I/We also understand that it is impossible for The Lutheran High School of Kansas City's Administrators, Faculty and Staff to monitor or restrict access to all controversial materials when students are given access to the internet.  I/We hereby release The Lutheran High School of Kansas City, its operators, and any institutions with which it is affiliated from any and all claims and damages of any nature which may arise from my/our student’s use, or inability to use this access.  This policy will be in effect for the entire school year unless cancellation is submitted in writing. *
I/We accept The Lutheran High School of Kansas City’s practice to have my/our student drug tested (at the expense of the parents) if suspicion of drug or alcohol use exists. This is in accordance with our current policy regarding substance abuse. *
I/We submit this enrollment application, agreeing to the fees and policies of The Lutheran High School of Kansas City for the 2023-2024 school year. The enrollment of my child at The Lutheran High School of Kansas City may be withdrawn at any time if the information provided in this enrollment application, other enrollment application forms, and student interview is not accurate and complete. *
I/We understand registration fees are non-refundable. The school may hold records, including report cards and transcripts, if tuition or other school related bills are not paid in full. *
I/We understand that should I/we withdraw my/our child from The Lutheran High School of Kansas City anytime during the school year; all advance tuition paid to that point in time will become the property of The Lutheran High School of Kansas City. *
Electronic Signature
This Acknowledgement and Certification of Understanding ("Acknowledgement") is to let you know that by submitting an electronic signature, you are providing an electronic mark, that is held to the same standard as a legally binding equivalent of a handwritten signature provided by you. For purposes of the acknowledgement, a digital mark is considered a typed legal First and Last name (legal name may include middle name, initial or suffix) followed by the typed date.
Any document requiring an electronic signature may contain a signature acknowledgment statement provided in the same area requiring the electronic signature.
Please type First and Last Name of Parent and/or Legal Guardian *
I understand that by checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. Do you agree? *
Date of Signature *
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A copy of your responses will be emailed to the address you provided.
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