Online Student Enrollment Form - Agape Christian School

Student's Information

Application for Enrollment for Grade *Please select a grade level.

For the School Year *0 / 15

Student's First Name *

Student's Middle Name

Student's Last Name *

Name the Student prefers to be called

Sex *

Date of Birth *

Month

Day

Year

Age at September 1st *Please use the following format: 10 years 7 months0 / 18

Place of Birth: City/State *

Place of Birth: Country *

Home PhonePlease use the following format: 1-111-111-11110 / 14

Physical Handicaps *

National Insurance # *0 / 8

Family Mailing Address

Place of Residence: Street Address

Place of Residence: Apartment, suite, etc

Place of Residence: City/Settlement *

Place of Residence: State/Province/Island *

Place of Residence: Country *

Student Email Address

Does your child catch a bus, taxi and/or ferry to school? *

Please give details. *

Parent/Guardian's Information

(1) Parent/Guardian Details

Marital Status *

Please give details of marital status. *

Relationship to Student *

First Name *

Middle Name

Last Name *

Occupation *

Cell Phone Number *Please use the following format: 1-111-111-11110 / 14

Email Address *

Employer *

Daytime Phone #Please use the following format: 1-111-111-11110 / 14

(2) Parent/Guardian Details

Marital Status *

Please give details of marital status. *

Relationship to Student *

First Name *

Middle Name

Last Name *

Occupation *

Cell Phone Number *Please use the following format: 1-111-111-11110 / 14

Email Address *

Employer *

Daytime Phone #Please use the following format: 1-111-111-11110 / 14

Does the student have another parent/guardian whose information needs to be added?

(3) Parent/Guardian Details (Optional)

Relationship to Student

First Name

Middle Name

Last Name

Occupation

Cell Phone NumberPlease use the following format: 1-111-111-11110 / 14

Email Address

Employer

Daytime Phone #Please use the following format: 1-111-111-11110 / 14

Responsible Adults to Contact in Case of Emergency if a Parent Cannot be Reached

(1) Emergency Contact Details

First Name *

Middle Name

Last Name *

Relationship to Student *

Place of Residence: Street Address

Place of Residence: Apartment, suite, etc

Place of Residence: City/Settlement *

Place of Residence: State/Province/Island *

Place of Residence: Country *

Phone Number *Please use the following format: 1-111-111-11110 / 14

(2) Emergency Contact Details

First Name *

Middle Name

Last Name *

Relationship to Student *

Place of Residence: Street Address

Place of Residence: Apartment, suite, etc

Place of Residence: City/Settlement *

Place of Residence: State/Province/Island *

Place of Residence: Country *

Phone Number *Please use the following format: 1-111-111-11110 / 14

Student's Present Education Record

Name of School Presently Attending *

Present Grade *Please select a grade level.

Previous Grade Attended There *Please select a grade level.

School's P.O. Box

School's Email Address *

Principal's First Name *

Principal's Last Name *

School's Phone Number *Please use the following format: 1-111-111-11110 / 14

Siblings Attending Agape Presently

Does this student have any siblings presently attending Agape? *

First Name *

Middle Name

Last Name *

GradePlease select a grade level.

Does this student have another sibling presently attending Agape? *

First Name *

Middle Name

Last Name *

GradePlease select a grade level.

Does this student have another sibling presently attending Agape? *

First Name *

Middle Name

Last Name *

GradePlease select a grade level.

Additional Information

Upload files

Drag and Drop (or) Choose Files

Please upload any other relevant documents pertaining to the student such as a report card from the last grade completed and a passport picture.