kindergarten application - Grace Christian

Grace Christian School325 N. M140, Watervliet, MI 49098 Phone: 269.463.5545www.gcspatriots.cominfo@gcspatriots.comYoung 55 and Kindergarten Enrollment ApplicationReturn application(s) to GRACE CHRISTIAN SCHOOL with a $20 Application Fee per family (new families only).Registration fee of $100 is due upon acceptance of student. Application and registration fees are NON-REFUNDABLE.For Official Use OnlyFEE REC:LOA REC:APPTDT:APPRBY:Student InformationLast Name:First:Middle:Sex:D MaleD FemaleStreet Address:Social Security No.City.:State:Zip:IL_Home PhoneAdmissionis sought for school year:Age:Progam: D Young 5s (Half Day) D Kindergarten D Y5 (After Care)Date of Birth:ereferredfirst name to use for name writing and recognition:Family InformationFather or Guardian's Name EmployerI ~ 1'-----__ --Father AddressEmployer Phone1'--- 11_- _Home Phone Cell Phone Email Address Work Hrs/Days1 I I~ __ II~ II _Mother or Guardian's Name EmployerI 11 _Mother AddressEmployer Phone1 -IIHome Phone Cell Phone Email Address Work Hrs/DaysI I I~ __ II II _Other Children in FamilyNameAge

Religious InformationChurch Members? DYes D NoRegulary Attend? DYes D NoOccasionally Attend? DYes D NoChurch Name1 _Church AddressCit••..1 1[ y-Pastor's NameChurch Phone1 11_-Have you personally received Jesus Christ as your Savior?_FatherDYesMother DYes D NoGeneral InformationHow did you hear about Grace Christian School?Was anyone instrumental in your selecting GCS? DYes D No If yes, WhO?I~ _What is your reason for selecting GCS?Additional Information (This information will be used for Grandparent's Day)Mother's ParentsAddressFather's ParentsAddressIs there a non-custodial parent who should be receiving information?DYes D NoName and AddressIFather's Signature•.... 1 1 I~ _Mother's Signature 1 ---'1 1.... _03-09-12