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– Step 1 of 6

Family Information

Father's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Marital Status *

Married
Separated
Divorced
One Parent
Widower

Father's Occupation/Title *

Place of Employment *

Work Phone *

Email Address *

accepted Work (copy)

Mother's Name *

First

Last

Address (If Different than Father's)

Address Line 1

Address Line 2

City

State

Zip Code

Marital Status *

Married
Separated
Divorced
One Parent
Widower

Mother's Occupation/Title *

Place of Employment *

Work Phone *

Email Address *

If the student does not live with both parents, the student lives with *

both birth parents
birth mother only
birth father only
birth mother and stepfather
birth father and stepmother
guardian adoptive parents

Who has legal custody of the student? *

Written documentation is required prior to enrollment

Is either parent forbidden by court order from having equal access to the child or the school records? *

Written documentation required

What is the primary language spoken at home? *

Second language?

Children

Name *

Age *

Grade *

Present School *

Applying to Calvary Schools of Holland? *

Name *

Age *

Grade *

Present School *

Applying to Calvary Schools of Holland? *

Name

Age

Grade

Present School

Applying to Calvary Schools of Holland?

Name

Age

Grade

Present School

Applying to Calvary Schools of Holland?

Paternal Grandparents

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Maternal Grandparents

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Christian Commitment & Church Involvement

Father accepted Christ as Savior? *

Mother accepted Christ as Savior? *

Church Affiliation & Denomination *

Church Members? *

What activities are you or members of your family involved in besides Sunday worship? *

What factors have provided the greatest impact on the spiritual life of your family? *

What do you think are the characteristics of a Christian family? *

How would you describe your child spiritually? *

Has your child made a personal decision for Christ? *

If yes, at what age?

Interest in spiritual matters *

Strong
Growing Interest
Indifferent
Antagonistic

Student Information

Student #1

Admission date desired *

Grade for which applying *

Last Name *

First Name *

Middle Name *

Gender *

Male
Female

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Telephone *

Family Email Address *

Date of Birth *

Place of Birth *

Ethnicity *

Please describe your son or daughter's characteristics and tempermant *

Student #1 – School History

Is this your child’s first school experience? *

School 1

Name of School *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Last Grade Level Completed/Currently in *

Dates of Enrollment *

School 2

Name of School *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Last Grade Level Completed/Currently in *

Dates of Enrollment *

How would you describe your child as a student? Check all that apply. *

Excels academically
Above average
Average
Dislikes school
Likes school
Highly motivated
Indifferent
Struggles academically

Does your child have a learning disability? If so, please explain. *

What school district do you currently reside in? *

Include any mental, emotional, or special physical situation that may affect your child's activities or progress. *

Does your child receive medication? *

Type of medication *

Does your child have allergies to medication? *

Type of medication *

Does your child have allergies to food? *

Type of food *

Does your child have any other allergies? *

Other allergies *

List any honors/awards your child has won *

List any special abilities or gifts your child possesses *

Has your child ever been retained in any grade? If yes, please explain. *

Has your child ever been expelled, denied re-enrollment, counseled not to return to a school or been the subject of any major school disciplinary action? If yes, please explain. *

Has your child ever been to juvenile court? If yes, please explain. *

Has there been any known drug use by your child? If yes, please explain. *

Most difficult subject *

Least difficult subject *

If you wish to apply for additional students, please follow the prompts to submit additional Student Information Forms following submission of this application.

Supplemental Information

Why do you want your child(ren) to attend Calvary Schools of Holland? *

How did you hear of the school? *

Are you here as a result of a referral from a Calvary Schools of Holland family? *

Family Name *

Has either parent graduated from CSH? *

Have you been satisfied with the education your child has had until now? *

If not, in what areas do you desire improvement? *

What expectations do you have of the education your child will be receiving at Calvary Schools of Holland? *

Why do you want to attend or not to attend Calvary Schools of Holland? *

If your child is seeking admission at this time and will enter the 6th grade or above, please have him or her complete the following question.

I accept the policies of Calvary Schools of Holland and I authorize the school to hold my child accountable to Calvary standards and policies. Further, I agree to have my child taught according to the doctrinal position of the school. I accept the policies detailed in the Student Handbook and agree to abide by the school’s discipline policies. I promise to pay my financial obligations to Calvary on or before the due date or accept the consequences of the delinquent tuition policy. I give consent for my child to take part in all school activities, including sports and school-sponsored trips away from school premises, and absolve the school of liability because of injury to my child during school activities accept for the willful, wanton, or reckless misconduct of Calvary, its employees, or volunteers. I pledge my cooperation in regular tuition payments, practical service, prayer, and special gifts as the Lord enables me. I understand that any false information or significant omissions may disqualify my child from admission and may be justification for dismissal from Calvary if discovered at a later date. Finally, I give permission to have my son or daughter’s photograph used in school related print and web-based publications.

NON-DISCRIMINATORY POLICY
In accordance with Title VI of the Civil Rights Act of 1964, it is the policy of Calvary Schools of Holland to admit students of any race, color, national ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, class assignments, scholarship programs, and other school-administered programs.

I have read the terms stated on this application and agree.

Name *

Date *

Email *

Family Information

Children

Paternal Grandparents

Maternal Grandparents

Christian Commitment & Church Involvement

Student Information

Student #1

Student #1 – School History

School 1

School 2

If you wish to apply for additional students, please follow the prompts to submit additional Student Information Forms following submission of this application.

Supplemental Information

I have read the terms stated on this application and agree.

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