New Admission Application 2018-19
Student Information
First name
Your answer
Middle name
Your answer
Last name
Your answer
Preferred name/nickname
Your answer
Gender
Age of child as of 09/01/18
Your answer
Address
Street, City, State, Zip
Your answer
Home phone
Your answer
Date of birth
Your answer
Grade/Class
**All children applying for three year old class and older must be potty trained**
Days/week
Will your child be attending extended care
If so, for which times?
Select all that apply
Parent/Guardian 1 Info
Relationship to student (Parent/Guardian 1)
Your answer
Name (P/G 1)
Your answer
Mobile phone (P/G 1)
Your answer
Address (P/G 1 - if different from above)
Street, City, State, Zip
Your answer
Email (P/G 1)
Your answer
Occupation (P/G 1)
Your answer
Employer (P/G 1)
Your answer
Work phone (P/G 1)
Your answer
Driver's License (P/G 1)
Your answer
Parent/Guardian 2 Info
Relationship to student (Parent/Guardian 2)
Your answer
Name (P/G 2)
Your answer
Mobile phone (P/G 2)
Your answer
Address (P/G 2 - if different from above)
Street, City, State, Zip
Your answer
Email (P/G 2)
Your answer
Occupation (P/G 2)
Your answer
Employer (P/G 2)
Your answer
Work phone (P/G 2)
Your answer
Driver's License (P/G 2)
Your answer
Parents still living
Select all that apply
Student lives with
Please select one:
Custodial and Non-custodial Parents
IN CUSTODY CASES, LEGAL DOCUMENTATION MUST BE ON FILE IN THE SCHOOL OFFICE.
PLEASE PROVIDE US WITH VALID AGREEMENT OR ORDERS CONCERNING CUSTODY OR VISITATION FOR YOUR CHILD.
May non-custodial parent visit during school hours?
May child be released to non-custodial parent?
If yes, what is the name of the non-custodial parent
Your answer
If yes, what is the phone number of the non-custodial parent
Your answer
Siblings
Sibling 1 Name
Your answer
Sibling 1 Age
Your answer
Sibling 1 School
Your answer
Sibling 2 Name
Your answer
Sibling 2 Age
Your answer
Sibling 2 School
Your answer
Sibling 3 Name
Your answer
Sibling 3 Age
Your answer
Sibling 3 School
Your answer
If your child has more siblings, please list their names, ages, and schools here
Your answer
Please tell us about your child
What special qualities does your child possess?
Your answer
What special needs, if any, does your child have?
Your answer
What are your child’s strengths?
Your answer
Has your child experienced any social or behavioral problems?
If so, please share details...
Your answer
What language is primarily spoken at home?
Your answer
What other information would you like to share about your child?
Your answer
Special Health or Education Requirements
Has your child attended school before?
If yes, please name other school(s) your child has attended
Your answer
Special educational needs:
Your answer
Physical Handicaps or Limitations (glasses, scoliosis, hearing, etc.)
Your answer
Name and Phone # of Physician or Pediatrician for above issue(s)
Your answer
Has your child been treated for emotional or psychological needs?
If yes, name and phone # of Physician or Pediatrician for above issue(s)
Your answer
Please list any special medications your child takes (allergies, asthma, etc.)
Your answer
Please list any allergies your child has
Your answer
Please give physician names and phone numbers for the last two questions (if they are different from those listed above)
Your answer
Please list any serious illness, injury or hospitalization in the last year
Your answer
Signature
TO THE BEST OF MY KNOWLEDGE THE ENCLOSED PREVIOUS INFORMATION PROVIDED IS CORRECT AND CURRENT.
Type your name and the date as a signature
Your answer
Parent Handbook
In the continued effort to be as “green” as possible MacArthur Park Lutheran School website will now be the primary source for distributing the Student/Parent Handbook. This information is available at www.macparkschool.org. If you will like a copy of the handbook please check below:
Paper copy.... *
Church Information
Name of church affiliation
Your answer
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