Student Application Form

PERSONAL DATA

1. Date of Application *This question is required. This question requires a valid date format of DD/MM/YYYY.

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2. Student Legal Name *This question is required.

Space Cell	First Name	Last Name	Middle Name
Student	Student: First Name	Student: Last Name	Student: Middle Name

3. Date of Birth *This question is required. This question requires a valid date format of DD/MM/YYYY.

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4. Please upload a photocopy of the Birth Certificate:

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5. Does your child have an up to date Immunization record? *This question is required.

6. If you do have a copy of the immunization record, please upload a copy.

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6. Gender *This question is required.

7. Start Date Requested *This question is required. This question requires a valid date format of DD/MM/YYYY.

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To register for Kindergarten your child must turn 5 years of age on or before December 31 of the coming school year.

9. Please upload a copy of the student's latest report card if available

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9. Primary Guardian Info and Home Address of Student *This question is required.

Space Cell	Last Name	First Name	Middle Name	Relationship	Phone Number	Email
Primary Guardian 1	Primary Guardian 1: Last Name	Primary Guardian 1: First Name	Primary Guardian 1: Middle Name	Primary Guardian 1: Relationship	Primary Guardian 1: Phone Number	Primary Guardian 1: Email
Primary Guardian 2 (if not applicable, put n/a)	Primary Guardian 2 (if not applicable, put n/a): Last Name	Primary Guardian 2 (if not applicable, put n/a): First Name	Primary Guardian 2 (if not applicable, put n/a): Middle Name	Primary Guardian 2 (if not applicable, put n/a): Relationship	Primary Guardian 2 (if not applicable, put n/a): Phone Number	Primary Guardian 2 (if not applicable, put n/a): Email

10. Preferred Teacher/Parent Contact: *This question is required.

11. Legal Address *This question is required.

*Include postal code

12. Mailing Address (if different)

*include postal code

13. Emergency Contacts - other than parents/guardians (in order of preference). *This question is required.

Space Cell	Last Name	First Name	Relationship	Phone Number	Can Pick Up Child? (Yes/No)
Emergency Contact #1	Emergency Contact #1: Last Name	Emergency Contact #1: First Name	Emergency Contact #1: Relationship	Emergency Contact #1: Phone Number	Emergency Contact #1: Can Pick Up Child? (Yes/No)
Emergency Contact #2	Emergency Contact #2: Last Name	Emergency Contact #2: First Name	Emergency Contact #2: Relationship	Emergency Contact #2: Phone Number	Emergency Contact #2: Can Pick Up Child? (Yes/No)
Emergency Contact #3	Emergency Contact #3: Last Name	Emergency Contact #3: First Name	Emergency Contact #3: Relationship	Emergency Contact #3: Phone Number	Emergency Contact #3: Can Pick Up Child? (Yes/No)

14. Secondary Parent/Guardianship
**Please provide the school with court documents proving guardianship or a letter from the primary contact indicating rights to the student.

Space Cell	Last Name	First Name	Middle Name	Relationship	Phone Number	Email
Secondary Guardian 1	Secondary Guardian 1: Last Name	Secondary Guardian 1: First Name	Secondary Guardian 1: Middle Name	Secondary Guardian 1: Relationship	Secondary Guardian 1: Phone Number	Secondary Guardian 1: Email

15. Upload copy of Court Documents referred to in the question above.

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16. Secondary Parent/Guardian Address:

*Include postal code

17. Secondary Parent/Guardian - Other Instructions or Requests?

PREVIOUS SCHOOL INFORMATION

18. Name of School Student is Currently Attending or Attended Last Year *This question is required.

20. Has This Student Ever Repeated a Grade? *This question is required.

21. Is This Student on an Individual Education Plan (IEP)? *This question is required.

22. Was the IEP a Modified program or an Adapted program?

22. Please upload a copy of the latest IEP program.

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23. Does the student have a diagnosis? Please explain and upload relevant documents regarding testing and diagnosis, if available.

23. Diagnosis/assessment documentation

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24. School Contact Numbers *This question is required.

Space Cell	Office Phone	Email
Phone & Email	Phone & Email: Office Phone	Phone & Email: Email

25. School Contact Names *This question is required.

Space Cell	Name of Principal	Name of Teacher
Contact Names	Contact Names: Name of Principal	Contact Names: Name of Teacher

CHURCH DATA

26. Church Info
(If you do not have a church, please put N/A)

Space Cell	Church Currently Attending	Name of Pastor	Number of Years in Attendance
Church 1	Church 1: Church Currently Attending	Church 1: Name of Pastor	Church 1: Number of Years in Attendance
Church 2 (if previously attending a different church)	Church 2 (if previously attending a different church): Church Currently Attending	Church 2 (if previously attending a different church): Name of Pastor	Church 2 (if previously attending a different church): Number of Years in Attendance

Not all families at MCS regularly attend church, however; all students enrolled at MCS must participate in weekly chapel services and be respectful and open to learning about the Bible. Parents must play a supportive role in this regardless of their personal beliefs.

PERSONAL INFORMATION AND PRIVACY ACT

Mountain Christian School will only use, disclose and retain personal information for the purpose for which it was collected unless the individual has otherwise consented, or when its use, disclosure or retention is required or permitted by law. Please refer to our student/parent handbook or our website for the complete policy.

POLICIES AND PROCEDURES

Student/Parent handbooks are sent home at the beginning of the year with all students. (also available on the website)

MCS Policy and Procedure Manual is stored in the school office and may be signed out by school members at any time. Current Policies and Revisions will be posted on our website.

Student Application Form

Form A - Student Application