REDEEMER
LUTHERAN CHURCH AND SCHOOL
1261
Pennsylvania Ave. Oakmont, PA
15139
Phone
412/828-9323 Fax
412/828/1860
Dr.
Rev. Jonathan Naumann, Pastor
Mrs.
Gail Holzer, Principal
APPLICATION FOR ENROLLMENT -
NEW STUDENTS
2008-2009
Preschool Classes 3
Yr. Class (AM) __ (PM) __ 4
Yr. Class (AM) __ (PM) __ Enrichment ___
Elementary
Classes K __ K & Enrichment __
1 __ 2 __ 3__ 4 __ 5 __ 6 __ 7__ 8__
STUDENT
INFORMATION
Child’s Name:
_________________________________________________/___________________
(Last)
(First)
(M.I.)
(Name
your child is to be called in school)
Address: _____________________________________ Phone Number: ( )_______________
(Street)
(City & State)
(Zip)
Circle One:
Male
Female
Date of Birth:
____-____-____ Date of Baptism: ____-____-____
School District in which you
reside: ____________________________________________________
Will your child be using
your District Bus Transportation? (K – 8 applicants only) ( ) Yes ( ) No
Previous School and Address:
_______________________________________________________________
PARENT
INFORMATION
Parents: Married ____
Separated ____
Divorced ____
Note: If parents are divorced, you will receive
a separate custody form to complete.
Father: ________________________________________ Legal
Guardian? ( ) Yes ( )
No
(Last)
(First)
(M.I.)
Address: (if different from above) ________________________________________________________
(Street)
(City & State)
(Zip)
Phone: (Home) ( ) _____________ Cell: ( ) _____________ Work: ( ) _______________
Occupation:
________________________________________ Employer: ___________________
Mother: ___________________________________________ Legal Guardian? ( )
Yes ( ) No
(Last)
(First)
(M.I.)
Address: (if different from above) ________________________________________________________
(Street)
(City & State)
(Zip)
Phone: (Home) ( ) ______________ Cell: ( ) ______________ Work:
( )
_______________
Occupation:
________________________________________ Employer: ___________________
Primary Family Email address:_____________________________________
FAMILY INFORMATION
Names and birth dates of all other children in the household:
__________________________________________ ____________________________________
__________________________________________
____________________________________
|
Does your child need
any special academic or health services: (
) Yes ( ) No If yes, please explain:
______________________________________________________ _______________________________________________________________________ Does your child have an
IEP? ( ) Yes
( ) No If yes, it must be made
available to the Principal prior to enrollment |
Present
Church Membership:
______________________________________________________________________
Do
Parents Attend? ( ) Yes ( ) No
Does
Child regularly attend Sunday School? ( )
Yes ( ) No
If
you are not an active member of a Christian church, we invite you to attend
Adult Information classes conducted by our Pastor. You are also invited to attend our weekly Worship Services
at Redeemer Lutheran Church, Sunday mornings, 10:45 am, and Sunday School
Classes at 9:30 am.
Emergency
Information: *Person
to contact if parent is not available:
1.
____________________________________________ Phone: (
) __________________
Relationship to child: _____________________________________________________
2.
____________________________________________ Phone: (
) __________________
Relationship to child:
_____________________________________________________
*I, ___________________________________, give permission for my child,
________________
to be treated by emergency medical personnel if I cannot be reached.
Emergency
Information such as conditions, allergies, diseases etc., a medical team would
need to know to safely treat your child:
Rate Schedule: Is attached and becomes part of this agreement.
Final Action: All applications from enrollment are subject to the approval of
Redeemer Lutheran School Board.
I have read the application and the attached rate schedule, and would
like to enroll my child in Redeemer Lutheran School.
Signature of parent or legal guardian
__________________________________________
Please
send this enrollment application, along with the registration fee payable to:
Redeemer
Lutheran School
1261
Pennsylvania Ave. Oakmont, PA
15139
Redeemer Lutheran School admits students of any race, color, national and 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 and athletic and other school-administered programs.