Application | Zarephath Academy

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Zarephath Academy

K-12

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Application for Enrollment
ZAREPHATH ACADEMY

Application Only Available on Desktop Browers

NOTE: APPLICATION MUST BE COMPLETED BY THE FAMILY WHERE THE CHILD RESIDES

Student

First Name

Middle Name

Last Name

Date of Birth

Age

Address

Phone

Grade Entering

A. Family Information

Parents Status

Child Lives With:

Parent / Guardian 1

Parent / Guardian 2

If living w/ someone other than parents

Address

Phone

Email

Employment Information:

Parents Status

Emplyer Name

Business Address

Business Phone

Other Children in Family

First Name

Age

Grade

School

First Name

Age

Grade

School

First Name

Age

Grade

School

B. Information Concerning Grandparents

Paternal Grandfather

Phone

Address

Paternal Grandmother

Phone

Address

Maternal Grandfather

Phone

Address

Maternal Grandmother

Phone

Address

C. Church Information:

Person

Church Name

Attendance

Person

Pastor Name

Phone Number

Length of time at church

List church activities in which your family participates

Person

Church Name

Attendance

Person

Pastor Name

Phone Number

Length of time at church

List church activities in which your family participates

D. Academic Information:

Repeated a grade in school?

Yes

No

Had disciplinary difficulties in school?

Yes

No

Been tested for a learning difficulty?

Yes

No

Attended Resource Class?

Yes

No

Attended summer school?

Yes

No

Had extended absences from school?

Yes

No

Attended Speech Therapy classes

Yes

No

Attended Gifted/Talented?

Yes

No

Been expelled from school?

Yes

No

Please explain any questions answered YES

E. Health Information

Repeated a grade in school?

Yes

No

Has the child ever been arrested, taken illegal drugs, received treatment for substance abuse?

Yes

No

If yes, please explain

G. General Information

How did you hear about Zarephath Academy?

Your Signature

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Application for Enrollment ZAREPHATH ACADEMY

Application Only Available on Desktop Browers

NOTE: APPLICATION MUST BE COMPLETED BY THE FAMILY WHERE THE CHILD RESIDES

Student

A. Family Information

Child Lives With:

Employment Information:

Other Children in Family

B. Information Concerning Grandparents

C. Church Information:

D. Academic Information:

E. Health Information

G. General Information

Application for Enrollment
ZAREPHATH ACADEMY