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Parent Information

With whom does student live?*

Who has legal custody?*

If separated or divorced, both parents will appear in the Student Directory and receive Christ Church School mailings.

Church Membership*Christ Church United MethodistOther

Church Name*

Parent/Guardian 1

Please Choose One*MotherFatherGuardian

Parent/Guardian 1 Email*

Parent/Guardian 1 Prefix*Dr.Mr.Mrs.Ms.

Parent/Guardian 1 First Name*

Parent/Guardian 1 Last Name*

Parent/Guardian 1 Street Address (if different from above)

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Parent/Guardian 1 Home Phone - -

Parent/Guardian 1 Cell Phone - -

Parent/Guardian 1 Work Phone - -

Parent/Guardian 1 Employer*

Parent/Guardian 1 Occupation*

Parent/Guardian 2

Please Choose One MotherFatherGuardian

Parent/Guardian 2 Email

Parent/Guardian 2 PrefixDr.Mr.Mrs.Ms.

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Address (if different from above)

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Parent/Guardian 2 Home Phone - -

Parent/Guardian 2 Cell Phone - -

Parent/Guardian 2 Work Phone - -

Parent/Guardian 2 Employer

Parent/Guardian 2 Occupation

Please attach copies of Letters of Guardianship or other court orders respecting custody if applicable.

File Upload 1

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File Upload 2

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Grandparent Information

Grandparents of current students will receive invitations to special events. Please name living grandparents and list their addresses.

Grandparent 1 PrefixDr.Mr.Mrs.Ms.

Grandparent 1 First Name

Grandparent 1 Last Name

Grandparent 1 Address

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Grandparent 1 Email

Grandparent 1 Phone - -

Would you like to add a second grandparent?

Grandparent 2 PrefixDr.Mr.Mrs.Ms.

Grandparent 2 First Name

Grandparent 2 Last Name

Grandparent 2 Address

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Grandparent 2 Email

Grandparent 2 Phone - -

Would you like to add a third grandparent?

Grandparent 3 PrefixDr.Mr.Mrs.Ms.

Grandparent 3 First Name

Grandparent 3 Last Name

Grandparent 3 Address

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Grandparent 3 Email

Grandparent 3 Phone - -

Would you like to add a fourth grandparent?

Grandparent 4 PrefixDr.Mr.Mrs.Ms.

Grandparent 4 First Name

Grandparent 4 Last Name

Grandparent 4 Address

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Grandparent 4 Email

Grandparent 4 Phone - -

Additional Information Required

Last School Attended

Principal/Director

School Address

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

School Phone - -

How Long at Last School

Reason for Leaving

Special Medication or Medical Conditions*

Has your child been identified as gifted/talented or double promoted?*

Has your child ever been referred/evaluated for physical, developmental, academic, social or psychological concerns?*

Has your child experienced any discipline/conduct problems, grade retention(s), school suspensions, and/or dismissals?*

If ‘Yes’ to any of the above, please explain here:

How did you hear about Christ Church School?*

Siblings

Name and age of brother/sister

School attending

Grade entering

Name and age of brother/sister 2

School attending 2

Grade entering 2

Christ Church School has an “Open Admission Policy” without discrimination as to race, religion, ethnic origin, gender and other protected categories. Though ours is a church school, it is open to all qualified applicants regardless of church affiliation whose parents wish them to participate in the program.

Signature

Parent/Guardian 1 Signature*

Date*

Parent/Guardian 2 Signature

Date

$100.00 Application Fee + Credit Card Service Fee$103.30

Payment Method:*

Payment Notes/Additional Info:

Name on Card:*

Email You Want Associated with Credit Card Payment:*

Credit or debit card*