CHILD ENROLLMENT INFORMATION
Please fully complete form, forms not fully completed will not be accepted.
Parent's Information
Mother's Information:
Address:
Father's Information:
Address:
Child's Information
Marital Status
IF DIVORCED, Please describe custody and visitation agreement for the child. If custody is limited you must provide custody papers.
Others in household:
Medical Information
IN THE EVENT OF A TRUE EMERGENCY, 911 WILL BE CONTACTED AND EMERGENCY PROCEDURES FOLLOWED.
Other persons to be notified in case of illness or accident and are permitted to remove child:
Miscellaneous
How did you hear about Lighthouse Christian School?
Are you a member of First Presbyterian Church?
Attending School:
Entering Grade:
Today's Date:
Mom's Email:
Dad's Email:
Password:
Child's Name:
Nickname (If any):
Address:
Date of Birth:
City:
State:
Zip Code:
Mother's Name:
Cellular Phone:
Work Phone:
Place of Employment:
Position:
Father's Name:
Cellular Phone:
Work Phone:
Place of Employment:
Position:
Detail: (Custody and Visitation Agreement)
Name, Age & Relationship:
Name, Age & Relationship:
Name, Age & Relationship:
Child's Physician:
Phone:
Allergies:
Food Problems:
Any other physical problems we should be aware of ?
Name:
Phone Number:
Address:
Address:
Name:
Phone Number:
If referred by an attending school family please list name here (Leave blank if NONE):
