Which parent will assume responsibility for student’s tuition? (Circle one)
Parent #1
Parent #2
Both Parents
Siblings (name, age, present school)
Please tell us what you are looking for in a school:
Please tell us something about your child. Are there any particular strengths or areas of concern that you would like to bring to our attention? (Attach additional paper, if necessary)
How did you learn about CBES?
If your child has attended any other school than that indicated above, please list here:
Child
School Name and Location
Name of Teacher, Guidance Counselor or Principal
Dates of Attendance
Parent Signature
Date
The Concord Baptist Elementary School does not discriminate on the basis of religion, race, color, national or ethnic origin, or sexual orientation in its admissions, policies, or educational program. All acceptances will be in writing; registration is considered complete upon signing and returning the enrollment contract and paying the tuition deposit.
The Concord Baptist Elementary School
Additional Enrollee Information
Full Name of Applicant
Preferred Name
Date of Birth
Place of Birth
Applicant for grade
Year Entering
Male
Female
Applicant’s present school, if any
School address
Street
City
State
Zip code
School(s) previously attended, if any
Is English the applicant’s native language?
Yes
No
If no, what language is spoken at home?
Complete information for Parent/Guardian #1
Mr. Mrs. Ms. Dr. Rev. (Circle one)
(First Name)
(Last Name)
Relationship to applicant: (Circle one)
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Foster Parent
Other
Home address
City
State
Zip code
Home telephone
Business telephone
Cell Phone
E-mail address:
Present occupation
Title
Employer
High School/College attended
Complete information for Parent/Guardian #1
Mr. Mrs. Ms. Dr. Rev. (Circle one)
(First Name)
(Last Name)
Relationship to applicant: (Circle one)
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Foster Parent
Other
Home address
City
State
Zip code
Home telephone
Business telephone
Cell Phone
E-mail address:
Present occupation
Title
Employer
High School/College attended
With whom does the applicant live? (Circle one)
Parent #1
Parent #2
Both Parents
Which parent will assume responsibility for student’s tuition? (Circle one)
Parent #1
Parent #2
Both Parents
Siblings (name, age, present school)
Please tell us what you are looking for in a school:
Please tell us something about your child. Are there any particular strengths or areas of concern that you would like to bring to our attention? (Attach additional paper, if necessary)
How did you learn about CBES?
If your child has attended any other school than that indicated above, please list here:
Child
School Name and Location
Name of Teacher, Guidance Counselor or Principal
Dates of Attendance
Emergency Contact Information
Ease of contact with a parent/guardian and/or your designated other emergency contacts ensures that we can focus our attention in getting your child the care and attention she/he needs. It also helps us keep you informed of any and all emergencies. Please make sure that the information provided here is accurate because it is what we will have on hand in case of an emergency involving your child. Should your child be enrolled in our school, we will periodically encourage you to update this information as the school year progresses.
Child’s Name
Date of Birth
Please list your (parent/guardian’s) emergency contact information first. Then, in order of preference, list the emergency contact information for at least two additional people.
Your Emergency Contact Information
Parent’s Name:
Home:
Work:
Cell:
Other:
Contact #1
Name:
Relationship to child:
How well does the child know this contact?
Street Address
Cross Streets
City
State
Zip code
Telephone Numbers:
Home:
Work:
Cell:
Other:
Contact #2
Name:
Relationship to child:
How well does the child know this contact?
Street Address
Cross Streets
City
State
Zip code
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