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ADMISSION PROCEDURES – GRADES K-8

1. NEW STUDENTS

A. Complete all information requested. PLEASE PRINT. NOTE: Also read page 4 on the back. Sign and date the bottom of page 4.

B. Include the following:

1. Latest Standardized Test results

2. Most current report card

3. Kindergarten applicants: birth certificate showing student will be 5 years old by October 1. Also, a complete health check-up is required prior to entering school in August.

C. An entrance test will be administered after all required documents have been submitted. Applications will not be accepted without the $25.00 non-refundable Testing Fee or required documents.

D. The non-refundable Registration Fee is due upon acceptance.

E. Any tuition paid is non-refundable.

2. NOTICE OF NON-DISCRIMINATION POLICY

St. John’s Lutheran School does not discriminate on the basis of race, color, or national ethnic origin in

administration of our education policies, employment practices, admission policies, athletic, and other school

administered programs.

For School Year __________ - _______________ For Grade ____________________

Date of Expected Entry _____________________________

THE STUDENT – FAMILY & CHURCH

Student: ____________________________________________________________________ Sex ________

Address: ___________________________________________________________________________________

Street City Zip

Phone Number: ________________________________

Birthdate: _____________________________ Birthplace: ___________________________________

Child lives with: [ ] Father [ ] Stepfather [ ] Other

[ ] Mother [ ] Stepmother

Explain ______________________________________________________________________

Father’s Name: _______________________________ Mother’s Name: ____________________________

Employer: ___________________________________ Employer: ________________________________

Work Address: _______________________________ Work Address: ____________________________

Work Phone: _________________________________ Work Phone: ______________________________

Occupation: __________________________________ Occupation: _______________________________

Are there any special custody arrangements of which we should be aware? ______________________________

___________________________________________________________________________________________

Names of brothers/sisters Age School

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

How did you hear about St. John’s Lutheran School?

[ ] Friend: _______________ [ ] Family: _______________ [ ] Other students here: _______________

[ ] Radio advertisement Which radio station? _________________________________________

[ ] Newspaper advertisement Which newspaper? __________________________________________

Reasons for applying for enrollment: _____________________________________________________________

___________________________________________________________________________________________

Family Church Membership: ___________________________________________________________________

[ ] Active [ ] Inactive

Pastor’s Name _________________________________________________

Child baptized? _______ Date of baptism _______________ Where baptized ________________________

Emergency contacts (if parents cannot be reached):

Name ______________________________ Relationship __________________________ Phone _______

Doctor _____________________________________________________________________ Phone _______

Check here if you do not want your child photographed or video-taped for school publicity. Students will not be identified by name.

THE STUDENT - PERSONAL

Last school attended _______________________________________________________________________

School address ____________________________________________________________________________

Date of attendance _________________________________________________________________________

Reason for leaving __________________________________________________________________________

Does your child have any specific education needs (reading, speech, gifted, remedial, etc.)? ________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Does your child have any physical, emotional, psychological needs or limitations (medications, handicaps)? ____

__________________________________________________________________________________________

Will any of the above require an adjustment in scheduled curriculum? [ ] Yes [ ] No

Has your child experienced any discipline / conduct problems, school suspensions, grade retentions, etc?

[ ] Yes [ ] No

Does your child have any allergies? [ ] Yes [ ] No Please explain below.

__________________________________________________________________________________________

If further explanation is needed, please use the space below. ________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

COVENANT & MEDICAL AGREEMENT

1. I/ We understand that application and/or testing for admission does not guarantee space in the class nor does it guarantee admission into St. John’s Lutheran School.

2. I / We certify this information to be complete and factual, and agree to fulfill all financial obligations. We agree to adhere to the policies and regulations as required by St. John’s Lutheran School as specified in the Parent Handbook and as updated in the school’s weekly newsletter.

3. I/We desire for our child an education which will include the study of God’s Word and the application of that Word into the daily life of our child. We will, therefore, support the school staff in order to maintain its high academic and citizenship standards. We understand that all children are expected to participate in weekly chapel services as well as daily devotions.

4. I/We invest authority in the school to correct our child, excluding corporal punishment, when his/her behavior or conduct interferes with learning activities. We understand that if, for any reason, our child does not conform to the school’s academic or citizenship standards, his/her enrollment may be terminated.

5. I/We grant permission for our child to use all of the play equipment and participate in all the activities of the school, including field trips and athletics.

6. I/We understand that the monthly tuition fee is due on the first of each month and is considered late if not received in the office by the tenth of each month, beginning August 1 and concluding June 1. We understand that a late fee of $20 is assessed if the tuition is not received on time and a $10 fee is assessed for each check not honored by the bank. Furthermore, we understand that enrollment may be terminated IF PAYMENT IS LATE BEYOND THE END OF THE MONTH. We also understand that in the event of our removal of our child from school for personal reasons, any fees already paid are non-refundable.

7. I/We understand that the staff has full authority concerning promotions, retentions, and similar concerns.

8. I/We hereby grant permission for the school to take whatever steps may be necessary to obtain emergency medical care if warranted. These steps may include, but are not limited to, the following: 1) Attempt to contact a parent, guardian, or person(s) listed on the emergency information form completed by us; 2) Attempt to contact the child’s physician, another physician, an ambulance, or have the child taken to an emergency hospital in the company of a staff member; 3) Any expenses incurred under number two above will be borne by us.

9. I/We hereby give consent to treatment and hospital care which is deemed advised by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the medical staff of any available medical facility. It is understood that this authorization is given to provide authority, and power to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

10. I/We, as parent(s) of the student applicant, do prayerfully and sincerely give our pledge and agreement to all items as stated above.

Signature(s): ________________________________________________________________________________

________________________________________________________________________________

Date: ___________________________________________