February 23, 2012

PK Apply Online

Contact Name *

Contact Email Address *

Program(s) Interested In: *

Five Day Program (M-F) 8:30-3:00 Five Day Program (M-F) 9:30-12:00 Three day Program (M. W. F) 8:30-3:00 Three Day Program (M. W. F) 8:00-12:00

Student Information

First Name *
Middle Name
Last Name *
Gender *
Age *
Birthday *
Place of Birth
Address
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Telephone

Family Information

Father's Full Name
Father's Occupation/ Place of Employment
College:Number of Years
Degree(s)
Marital Status:
Mother's Full Name
Mother's Occupation/Place of employment
Mother's CollegeNumber of Years
Mother's Degree(s)
Select
Names and Ages of Other Children:
Any other children applying at this time: *
Any Extended family or others living in the home:
Name of Current Church *
Church Address:
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Active Church Member:
Phone
Email

Supplimental Information

Does your child have any eating restrictions and/or allergies
Does your child have any specific fears we should be aware of (dogs, storms, etc..)
Describe your Child: (Personality, learning styles, strengths, challenges, etc.)
Is your child potty trained:
How has your child responded to previous school-type settings? (preschool, library, playgroup, church, etc..)
Does your child have any unique physical, emotional or learning needs
How did you hear of SCS
Why are you interested in sending your child to SCS
What are your expectations of SCS
What do you think are the characteristics of a Christian family
What Factors have provided the greatest impact on the spiritual life of your family:
Would you describe yourself as "born again" ? (John 3:3) On what do you base your answer:
State Briefly your personal relationship with Jesus Christ (Both Mom and Dad):

Verification

Please enter any two digits with no spaces (Example: 12)*