For office use only:
APPLICATION FOR ADMISSION
Application _____
Tuition Agreement _____
Fee _____
Emergency/Medical _____
For office
use
only: _____
Date
received
Screening _____
Application _____
APPLICATION FOR ADMISSION
Transfer of Records _____
Tuition Agreement _____
For office
only:
Feeuse
_____
Emergency/Medical _____
Enrollment
DateProcess:
received _____
Transfer of Records _____
1) FEE
Complete
enrollment
forms and submit
with
appropriate
Application
_____
___________
DATE RECEIVED
___________
Tuition
Agreement
_____non-refundable fee to:
Screening
_____
Lebanon
Road,
Lebanon,
OH 45036.
Fee _____Christian School, 1436 Deerfield
Emergency/Medical _____
Applications will be processed on first-come, first-served basis.
Date received _____
Transfer of Records _____
See Tuition insert or visit our web site at www.lebanonchristianschool.org
Enrollment
Process:
Screening
_____
for current fees.
1) Complete enrollment forms and submit with appropriate non-refundable fee to:
Christian
1436for
Deerfield
Road, Lebanon,
OH 45036.
2) Lebanon
Assessment
will beSchool,
conducted
new students
entering grades
K-8.
Applications
For
office
use
only:will be processed on first-come, first-served basis.
Enrollment
Process:
Tuitionenrollment
insert or visit
ourand
websubmit
site at with
www.lebanonchristianschool.org
1) See
Complete
forms
appropriate non-refundable fee to:
for
current
fees.
Lebanon
Christian
Road, Lebanon,
Application
_____ School, 1436 Deerfield
STUDENT
INFORMATION
Tuition Agreement
_____ OH 45036.
Applications
be
processed
on
first-come,
first-served
basis.
Fee
_____ will
2)
Assessment
will
be
conducted
for
new
students
entering
Emergency/Medical
_____grades K-8.
Student’sSee
Name
____________________________________________________________
Tuition
insert or visit our web site at www.lebanonchristianschool.org
Date received _____
Transfer of Records _____
for current
fees.If kindergarten or pre-kindergarten,
Grade Entering
_____
circle preference: A.M. P.M.
Screening _____
APPLICATION FOR ADMISSION
2) If
you have
not yet visited, attend our Open House.
STUDENT
INFORMATION
Address
__________________________________________________________________
Student’s
Name ____________________________________________________________
City
_________________________________________
_____
Zip _____________
3)
Assessment
will be conducted for new students State
entering
grades
K-8.
Enrollment Process:
Grade
Entering
_____
If
kindergarten
or
pre-kindergarten,
circle
preference:
A.M.
Age
_____
Birthday
________________________
Male
________
Female
________
1) Complete enrollment forms and submit with appropriate non-refundable
feeP.M.
to:
Lebanon
Christian
School,
1436
Deerfield
Road,
Lebanon,
OH
45036.
Address
__________________________________________________________________
Race
(optional)
Circle One: Black White Hispanic Asian Pacific Islands
STUDENT
INFORMATION
Applications
will be processed on first-come, first-served basis.
City _________________________________________
State _____ Zip _____________
Indian
Multi-Racial
See
Tuition
insert
or visitAmerican
our web site
at www.lebanonchristianschool.org
Student’s Name ____________________________________________________________
for_________________________________________________________________
current
fees.
Age _____
Birthday
________________________ Male ________ Female ________
Birthplace
Grade Entering _____ If kindergarten or pre-kindergarten, circle preference: A.M. P.M.
2)
Assessment
will
beatconducted
for
new __________________________________
students
entering
grades
K-8. Islands
Racelong
(optional)
Circle
One:
Black address?
White
Hispanic
Asian
Pacific
How
has student
lived
present
Address __________________________________________________________________
American
Indian
Multi-Racial
Has this student previously attended
Lebanon
Christian
School? _____________________
City _________________________________________ State _____ Zip _____________
Birthplace
_________________________________________________________________
School
attended
previous
year _________________________________________________
STUDENT
INFORMATION
Age _____ Birthday
________________________ Male ________ Female ________
How longschool
has student
lived
at present address? __________________________________
Previous
address
______________________________________________________
Student’s
Name
____________________________________________________________
Race (optional)
Circle One: Black White Hispanic Asian Pacific Islands
Has this
student
previously
attendedschools?
Lebanon
Christian School?
How
often
has this
student
changed
____________________________________
your
child
ever
been:
Grade
Entering
_____
If kindergarten
or pre-kindergarten,
circle_____________________
preference: A.M. P.M.
American
Indian Multi-Racial
How_____
often has
thisfrom
student
changed schools? Yes
____________________________________
__________________________________________________________________________
Age
Birthday
________________________
Female ________
Suspended
school?
 NoMale
 ________
Has this
student
previously
attended Lebanon Christian
School?
_____________________
Has
student
ever
been
_____
retained?
suspended?
Racethe
(optional)
Circle
Black
White______
Denied
admission
toOne:
any
school?
Yes Hispanic
 No
 Asian Pacific Islands
School
attended
previous
year
_________________________________________________
OnlyRequested
person(s) permitted
to pick
up
child
are:
____________________________________
Indian
not to return
to American
any
school?
Yes  Multi-Racial
No 
Previous school address
______________________________________________________
__________________________________________________________________________
Birthplace
How
often_________________________________________________________________
has
this student
changed schools? Yes
____________________________________
Asked
to leave
any preschool?
 No 
Howthe
longstudent
has
lived at
present
address?
__________________________________
Has
ever been
_____
retained?
______
suspended?
Tested
asstudent
gifted?
Yes
 No

Has
studentpermitted
previously attended Lebanon Christian School? _____________________
Onlythis
person(s)
Advanced
a grade? to pick up child are: ____________________________________
Yes  No 
School attended previous year _________________________________________________
__________________________________________________________________________
Issued an IEP? (Individualized Educational Plan) Yes  No 
Previous school address ______________________________________________________
Been a student of LCS before?
Yes  No 
How often has this student changed schools? ____________________________________
** If yes to any of the above, please attach a separate sheet giving a full explanation.
Enclose
anylike,
necessary
documentation.
If you
would
use
an
extra
of paper
to answer
any of the following:
Has
the
student
ever
been
_____piece
retained?
______
suspended?
1. Doespermitted
the student
have
educational
or physical needs?
Only person(s)
to pick
upspecial
child are:
____________________________________
2.
Please
describe
the
student’s
extra-curricular
interests and abilities.
__________________________________________________________________________
3. Does the student typically enjoy school?
4. Any unusual factors in the student’s life?
5. Is there
else you
would
like toto
telltell
usus
about
the child?
If you would
like, anything
use an extra
piece
of paper
anything
else you would
like us to know about your child.
Lebanon
Christian
School
Home Phone
School
attended
previous
year
_________________________________________________
Has
the
student
been
_____
retained? ______
suspended?
Retained
inever
a grade?
Yes  No

Address
__________________________________________________________________
Birthplace
_________________________________________________________________
Previous
school
address
______________________________________________________
Only
person(s)
permitted
to pick up child are: ____________________________________
City
State _____ Zip _____________
Expelled
from
school?
Yes
 No 
How_________________________________________
long has student
lived at present address?
__________________________________
Lebanon
Christian
School
Lebanon
Christian
Lebanon
School
Christian
School
FAMILY INFORMATION
Father’s Name ____________________________________________________________________________
FAMILY
INFORMATION
Address _________________________________________
City _____________ State _____ Zip __________
Home Phone _______________ Cell Phone ________________ Email _________________________________
Father’s Name ____________________________________________________________________________
Employer ____________________________________________________ Work Phone __________________
Address _________________________________________ City _____________ State _____ Zip __________
Home
Phone
_______________
Cell Phone ________________ Email _________________________________
Mother’s
Name
____________________________________________________________________________
Employer
____________________________________________________
Work Phone
Address ______________________________________________
City _____________
State__________________
_____ Zip __________
Home Phone _______________ Cell Phone ________________ Email _________________________________
Mother’s Name ____________________________________________________________________________
Employer ____________________________________________________ Work Phone _______________________
Address ______________________________________________ City _____________ State _____ Zip __________
Home Phone
_______________
Cell Phone
________________
Email _________________________________
Marital
relationship
in home (circle
one): Married
and living together
One parent deceased
Divorced
Employer ____________________________________________________
WorkSeparated
Phone _______________________
Natural parent and stepparent
Other
Marital
(circle
one):
Married
and living together
One parent deceased
Divorced
If parentsrelationship
are divorcedin
or home
separated,
what
is custody
arrangement?
________________________________________
Natural parent and stepparent Separated Other
________________________________________________________________________________________________
Please furnish copy of legal documents to office
If parents are divorced or separated, what is custody arrangement? ________________________________________
Siblings
________________________________________________________________________________________________
Name furnish
___________________________________
Age ________
School __________________________
Please
copy of legal documents to office
Name ___________________________________
Siblings
Name ___________________________________
Name ___________________________________
Age ________
School __________________________
Age ________
Age ________
School __________________________
School __________________________
Name ___________________________________
Age ________
School __________________________
Name ___________________________________
Age ________
School __________________________
Emergency Contacts
Emergency Contacts
Name ____________________ Relationship
Name
Name ____________________ Relationship
RelationshipContacts
Emergency
Name ____________________ Relationship
Home ____________________
Phone
Name
Relationship
_____________ Home Phone ___________ Work Phone ___________
Name
_____________ Home Phone ___________ Work Phone ___________
Relationship
_____________ Home Phone ___________ Work Phone ___________
Home
_____________
HomePhone
Phone ___________ Work Phone ___________
Work
Phone
Workdid
Phone
Name
____________________
Relationship
_____________
Home
Phone
___________
Work Phone ___________
How
you learn about LCS? Circle
one: referral,
drive by, newspaper,
church,
internet, other
Name
Relationship _____________ Home Phone ___________ Work Phone ___________
(please____________________
explain)__________________________________________________________________________________
How did you learn about LCS? Circle one: referral, drive by, newspaper, church, internet, other
(please
explain)__________________________________________________________________________________
If
you would
like, you may use an extra piece of paper to answer the following:
2. What particular talents or resources might your family bring to LCS?
1. What particular talents or resources might your family bring to LCS?
If you would like, you may use an extra piece of paper to answer the following:
2. What particular talents or resources might your family bring to LCS?
_____________________________________________________________________________
_____________________________________________________________________________
2. How did you learn about LCS? Circle one: referral, drive by, newspaper, church, internet, other
(For _____________________________________________________________________________
referrals, please indicate a current LCS family that most influenced your decision to attend.)
_____________________________________________________________________________
CHURCH INFORMATION
Church Attending ________________________________________________________________________________________
Address __________________________________________ City ________________ State _____ Zip __________
Pastor’s Name/Youth Pastor’s Name ____________________________________ Phone number _______________
How long have you and the student been attending? ______________________________
Does the student attend church regularly and participate in church activities? __________
Testimonies (OPTIONAL)
Please describe how you became a Christian and how your life has changed as a result of a personal relationship
with Jesus Christ.
Mother’s Testimony
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Father’s Testimony
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
TUITION PAYMENT AGREEMENT
I have read the attached Tuition Payment Agreement and choose to pay my tuition as follows:
*One year in advance (due August 1)
*Two-payment plan (due August 1 and December 1)
11 monthly payments (FACTS only / August through June)
* A LATE CHARGE OF $50.00 WILL BE ADDED TO PAYMENTS RECEIVED AFTER THEIR DUE DATE.
PARENT PLEDGE
In becoming part of the LCS family, we pledge to:
PARENT PLEDGE
• Uphold the Statement of Faith, included in the Application Packet, and support the school in
teaching
of thewe
Statement
of Faith to our child/ren.
In becoming
part ofthe
theelements
LCS family,
pledge to:
• Pray for the school family – teachers, staff, administrator, students, and families.
• Uphold the Statement of Faith, included in the Application Packet, and support the school in
theChristian
elementseducation
of the Statement
of Faith to our
• teaching
Support the
of our child/children
bychild/ren.
attending a Bible-believing church, and by
providing a nurturing, Christian home life.
• Pray for the school family – teachers, staff, administrator, students, and families.
educational
experience
by sharing talents/interests/hobbies/profession
with and by
• Enrich
Supportthe
theLCS
Christian
education
of our child/children
by attending a Bible-believing church,
the students
as the Lord
permits.
providing
a nurturing,
Christian
home life.
• Attend PTF (Parent-Teacher Fellowship) meetings and support programs as the Lord permits.
• Enrich the LCS educational experience by sharing talents/interests/hobbies/profession with
the students
as the Lord
permits.
• Volunteer
a minimum
of 20
hours per family/per school year or pay $60 fee.
Volunteer hours for preschool not required, 10 hours per school year/per family required
• Attend PTF (Parent-Teacher Fellowship) meetings and support programs as the Lord permits.
for prekindergarten.
• Volunteer a minimum of 20 hours per family/per school year or pay $60 fee.
• Resolve school-related conflicts by applying the principles found in Matthew 18.
Volunteer hours for preschool not required, 10 hours per school year/per family required
for prekindergarten.
• Meet
all financial obligations to LCS, including those remaining after child leaves LCS,
per the Tuition Payment Agreement.
• Resolve school-related conflicts by applying the principles found in Matthew 18.
• Give financial gifts as the Lord permits, through general donations or planned giving.
• Meet all financial obligations to LCS, including those remaining after child leaves LCS,
Tuition Payment
Agreement.
• per
Givethe
permission
for the named
child on this application and child’s family members to be
photographed at school-related events and for those photographs to be used by LCS for
• Give financial gifts as the Lord permits, through general donations or planned giving.
promotional purposes.
• Give permission for the named child on this application and child’s family members to be
• photographed
Invest authorityatinschool-related
the school to events
discipline
necessary with
consent.
andour
forchild
thoseasphotographs
to beparent
used by
LCS for
This includespurposes.
corporal punishment and the right to dismiss our child if he or she does not respect
promotional
the standard of conduct and the educational process adopted by the school.
• Invest authority in the school to discipline our child as necessary with parent consent.
• Understand
assessments
will be
made
to cover
damage
tochild
school
property
ournot
child/ren
This includesthat
corporal
punishment
and
the right
to dismiss
our
if he
or she by
does
respect
(including
breakage
of
windows,
abuse
of
books,
etc.)
the standard of conduct and the educational process adopted by the school.
••• Release
Lebanon
Christian School,
its employees,
and
representatives
from
any on
claim
we
may have
I agree that
the continued
enrollment
of mytochild
in damage
this
school
is dependent
parental
Understand
that
assessments
will be
made
cover
to school
property
bymy
our
child/ren
resulting
from
illness
injuries
sustained
by our
child/ren while under school supervision whether
support of
theany
school,
itsorstaff,
and
its policies.
(including
breakage
of windows,
abuse
of books,
etc.)
at school or away from school premises. We further agree to hold harmless LCS, its employees, and
representatives
from
any injury
or damage
which may
caused by our from
child/ren.
• Release
Lebanon
Christian
School,
its employees,
andbe
representatives
any claim we may have
resulting from any illness or injuries sustained by our child/ren while under school supervision whether
I pledge my at
commitment
to the
above:
school or away
from
school premises. We further agree to hold harmless LCS, its employees, and
representatives
from
any injury or damage which may be caused by
our______________________
child/ren.
Father’s Signature ______________________________________
Date
I pledge my commitment to the above:
Mother’s Signature ______________________________________ Date ______________________
Father’s Signature ______________________________________ Date ______________________
The Lebanon Christian School recruits and admits the students of any race, color, or ethnic origin to all the rights, privileges, programs and
Mother’s
______________________________________
Date
______________________
activities. In
addition, Signature
the school will
not discriminate on the basis of race, color, or ethnic origin
in administration
of its educational programs
and athletics/extra curricular activities. Furthermore, the school is not intended to be an alternative to court or administrative agency ordered,
or public school district initiated, desegregation. The Lebanon Christian School will not discriminate on the basis or race, color, or ethnic origin
in
hiring of
its certified
or non-certified
personnel.
ThetheLebanon
Christian
School
recruits and admits
the students of any race, color, or ethnic origin to all the rights, privileges, programs and
activities. In addition, the school will not discriminate on the basis of race, color, or ethnic origin in administration of its educational programs
and athletics/extra curricular activities.
Furthermore,
theSchool
schoolisis chartered
not intended
an alternative
Lebanon
Christian
by to
thebeState
of Ohio to court or administrative agency ordered,
or public school district initiated, desegregation. The Lebanon Christian School will not discriminate on the basis or race, color, or ethnic origin
in the hiring of its certified or non-certified personnel.
Lebanon Christian School is chartered by the State of Ohio
Lebanon Christian School is
a member of ACSI
(Association of Christian Schools International)
Lebanon Christian School is
a member of ACSI
(Association of Christian Schools International)
2/12
Lebanon Christian School
1436 Deerfield Road, Lebanon, Ohio 45036 • 513-932-5590
www.lebanonchristianschool.org
Lebanon Christian School
12/04
1436 Deerfield Road, Lebanon, Ohio 45036 • 513-932-5590
www.lebanonchristianschool.org
12/04