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Application for Enrollment
For academic year beginning August _2016_________
Today’s Date _____________________
Applying for grade __________________
STUDENT’S NAME________________________________________________________________________________________________
First
Middle
Last
Date of Birth _____________________________________ Place of Birth ____________________________________________________
Male _______ Female _________
Social Security Number ______________ - ______________ - ______________
Mailing Address____________________________________________________________________________________________________
Street
_________________________________________________________________________________________________________________
City
State
Zip Code
Student’s Home Phone _(_______)________-____________
Student’s First Language ____________________________
Other Language(s) _____________________________________________
Father’s Full Name_______________________________________ Father’s Email_____________________________________________
Father’s Home Phone ________________________________ Father’s Cell Phone___________________________________
Address (if different from above) ______________________________________________________________________________________
Employer ________________________________________________________________________________________________________
Name
Address
Phone
Mother’s Full Name______________________________________ Mother’s Email____________________________________________
Mother’s Home Phone_______________________________ Mother’s Cell Phone___________________________________
Address (if different from above) ______________________________________________________________________________________
Employer ________________________________________________________________________________________________________
Name
Address
Phone
Siblings ___________________________________________________________________________________________________________
Name
Gender
Birth Date
Grade
School
__________________________________________________________________________________________________________________
Name
Gender
Birth Date
Grade
School
Student Lives With (check all that apply): _____ Father _____ Mother _____ Step-father _____ Step-mother
_____ Other___________________________________________________________
Name / Relationship
Previous School(s) Attended (begin with the most recent):
__________________________________________________________________________________________________
Name
Address
Phone
__________________________________________________________________________________________________
Name
Address
Phone
__________________________________________________________________________________________________
Name
Address
Phone
May we contact the above school(s) for official transcripts and records? Yes____ No______
Are you applying to other schools? Yes____ No______
If yes, which schools?
_________________________________________________________________________________________________
Intentions for Enrollment: I intend for my child to complete the following program(s) at Pleasant Grove
Christian School:
______ Middle School
6th-8th Grades
______ High School
9th-12 th Grades
______ Individual Home
School Courses
Student Profile (to be completed by parent or guardian):
What phrases come to mind when describing your child?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
__________________________________________________________________________________________________
Please describe your child’s greatest strengths, both cognitive and social.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Please describe any behavioral, social and/or cognitive special needs of your child of which Pleasant Grove
Christian School should be aware.
___________________________________________________________________________________________________
!
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Does your child have any diagnosed learning disabilities?
Yes______ No_______
Has your child been enrolled in a special education program? Yes______ No_______
If so, does he/she have an Individual Education Plan? Yes______ No_______
Describe the remedial program/actions being taken.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Has your child ever been suspended from school or subject to any other serious disciplinary actions?
No________ Yes _________ If yes, please explain:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
____________________________________________________________________________________________________
Please describe your child’s interests, including extra-curricular activities.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Does your family attend Pleasant Grove Church? Yes________ No _________
Please describe your family’s church affiliation/involvement.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Please share any major events that have occurred during your child’s life of which Pleasant Grove Christian
School should be aware (relocation, death in the family, major illness, divorce, etc.).
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Pleasant Grove Christian School is a Christ-centered, non-denominational school that encourages and prepares its
students to grow in their personal faith in Jesus Christ, to pursue higher education, and to serve the Lord, their
families, and their community. Pleasant Grove Christian School believes that the spiritual growth of its students
gives meaning to all their intellectual and physical endeavors. By signing below, I fully acknowledge and
understand that my child will be taught spiritual truths in accordance with Scripture at Pleasant Grove Christian
School.
All applications must be accompanied by an application fee, a non-refundable $25 check, payable to Pleasant
Grove Christian School. Upon receipt of this application, all materials, documents and files comprising the
applicant folder become the property of Pleasant Grove Christian School. I understand that submitting this
application does not guarantee my child’s admission to Pleasant Grove Christian School. I understand that
admittance into Pleasant Grove Christian School’s Homeschool/Individual Course Program does not in any
way promise or guarantee admission to Pleasant Grove Christian School’s Full-Time Student Program.
Parent’s Signature ___________________________________________________Date ___________________________
I have read, understand, and agree to Pleasant Grove Christian School’s tuition/fees policy statement.
Parent’s Signature _______________________________________________ Date __________________________
I have read and understand the PGCS Statement of Faith. I agree _____/ disagree _____ with the Statement of
Faith. If you disagree, please tell us what about the statement is disagreeable to you.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Parent’s Signature ______________________________________________ Date __________________________
For Office Use Only
Application Fee Received on _______________
Student Accepted: _______ Yes
Check No. __________
________ No
__________________________________________________
Administrator’s Signature
_______________
Date
*Pleasant Grove Christian School is available to any student interested in receiving a Christian education.
PGCS admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and
activities generally accorded or made available to students at the school. PGCS does not discriminate on the
basis of race, color, national or ethnic origin in the administration of its educational policies, admissions
policies, scholarship, athletic, and other school-administered programs.