Request for Enrollment Form
PreK-8th 2017-2018
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Please fill out completely for each child you wish to be considered for enrollment.
Grade entering 2017-2018__________
Birth date_____/_____/_____
Name: (Legal) Last___________________________
First _______________________
Address: Street __________________________________
Home Phone: ________________________
Male_____
Female_____
Middle_________________________
City___________________________
Emails: _____________________________
Zip_____________________
_____________________________
List the parent(s) or guardian with which the child regularly resides. Circle applicable relationship to child.
Father / Stepfather - Name_______________________________________________
Employer_________________________
Work Phone __________________________
Mother / Stepmother – Name_____________________________________________
Employer_________________________
Occupation__________________________
Occupation___________________________
Work Phone __________________________
Child’s Ethnic Origin: Alaskan/American Indian
Asian/Pacific Islander
Cell Phone ______________________
Cell Phone _______________________
African-American
Caucasian
Hispanic
Other____
Brothers and Sisters living with the child:
Name_____________________________
Age______
School____________________________
Grade __________
Name_____________________________
Age______
School____________________________
Grade __________
Name_____________________________
Age______
School____________________________
Grade __________
Do you attend church?
What church do you attend?________________________________________________
Yes
Are you a member of this church?
How often do you attend church?
No
Yes
No
Occasionally
Once a month
Once a week
Twice a week
More than twice a week
Activities or areas of service in which you and/or your children are involved within your church: _____________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
cont.
Stillwater Christian School’s definition of “accepting Christ” is based upon having a “salvation” experience in accordance with Romans
3:23 “for all have sinned and come short of the glory of God” and Ephesians 2:8 “through grace are you saved, not of yourselves, it is a
gift from God, not by works”. This is a specific time that the individual can point to that they confessed they are a sinner, repented and
asked Jesus Christ to live in their heart and be evident in their life.
Has this child accepted Christ?
Yes
No
When__________________
Has the father or stepfather (with whomever the child regularly resides) accepted Christ?
Yes
Has the mother or stepmother (with whomever the child regularly resides) accepted Christ?
Has this child ever attended a Christian School before?
Yes
No
Yes
No
When_______________
When_______________
No
If so, where? ________________________________________________
Has this child ever been: (circle one)
Suspended
Expelled
Asked to withdraw
None
Why are you interested in private Christian education?___________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
How did you hear about Stillwater Christian School?__________________________________________________________________
School attended last year_____________________________________________________________ Grade ______________________
School address________________________________________
Would you need: Before school care______
City __________________
After school care_______
Both_______
State _________ Zip_____________
None_______
Read carefully. Initial and sign.
I am aware that this is only a questionnaire to be considered as an application for enrollment at Stillwater Christian School. This in no
way guarantees or implies that my child will be accepted as a student. I have read and understand the enclosed letter which reviews the
steps and processes for application and enrollment in Stillwater Christian School and understand them. Initials______
I am also aware that Stillwater Christian School negotiates contracts with teachers, support personnel, vendors, and services for the
entire year based upon the registration of my child; I understand that this is a contractual agreement. Should my child be accepted as a
student, I agree to pay my 2017-2018 tuition on a regular monthly basis, with the first payment being due August 1, 2017 and ending with
the last payment on May 1, 2018.
Initials_______
I further understand that my family enrollment fee is due at the time of submitting this application*. If my child is not accepted at SCS
my enrollment fee will be refunded to me. My enrollment fee is non-refundable for any other reason. My enrollment fee is attached.
Initials_______
__________________________________________________________
Parent Signature
____________________________________________
Date
*Enrollment Fee must be attached to this application to apply for enrollment:
Family enrollment fee paid by March 31 $200 per family
Family enrollment fee paid by June 15
$250 per family
Family enrollment fee paid after June 15 $300 per family
Stillwater Christian School admits students of any race, color, national and ethnic origin to all 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, scholarship and loan programs, and athletic and other school-administered programs.