Fayetteville Street Christian School
Application for Student Enrollment
(Please note that filling out and submitting this application does not guarantee enrollment in Fayetteville Street Christian School.)

  
  Date          
  Name of Child (Last, First, Middle, Nickname)      
Home Phone
       
  Address      
  Zip Code          
  Date of Birth Age of Child      
  SS Number Entering Grade      
  Check appropriate Box :     School Only        School and Extended Care       
               
  Information about the Family:        
  Father/Guardian Name      
  Home Phone        
  Address      
  Zip Code          
  Where Employed      
  Business Phone        Cell Phone      
  E-mail      
  Church Regularly Attending      
  Mother/Guardian Name      
  Home Phone        
  Address      
  Zip Code      
  Where Employed      
  Business Phone     Cell Phone      
  Church Regularly Attending      
  E-mail      
  Does child live with : Father    Mother   Both   Other                    
  Number of the other children in the family:   Boys       Girls      
  Please Bill:   Father    Mother    Other      
  Please Send Mailings to:       Father    Mother     Other      
  How did you hear about FSCS?      
               
  Information about your child:        
  List any known allergies      
  Please give any information concerning your child that will be helpful in his school experience    
  Please answer all questions accordingly:
Kindergarten - 12th grade - all questions
**Preschool only 		       
  School last attended      
  School Address      
  Has applicant ever repeated a grade?  No    Yes     What grade?      
  State reason for repeating      
  Does the applicant have any special musical abilities?   No      Yes      
  What talent?      
  Does applicant have any special athletic abilities?   No      Yes      
  What sport?      
  Does applicant have any special scholastic ability?   No       Yes       
  Please state      
  Religious:          
  Does the applicant understand the plan for salvation?   No    Yes       
  Has applicant ever accepted Christ as his/her Savior?   No    Yes      
  If yes, please state when      
  **Church Membership      
  Pastor     Phone number      
  Physical:            
  **Does applicant have any type of disability (mental, emotional or physical) that may affect his/her activities or progress?  No       Yes      
  If yes, please explain      
  Has the applicant missed more than ten (10) days of school last year?    No         Yes      
  If yes, please explain      
  Academic:          
  How would you rate the applicant in each of the following areas?        
 
Academic Ability Superior      Good     Average    Needs Help
**Self-Motivation Superior      Good     Average    Needs Help
Reading Ability Superior      Good     Average    Needs Help
Mathematical Ability Superior      Good     Average    Needs Help
Attitude toward learning and school Very Good      Good    Fair    Poor
     
  Fill in the grades your child received in each subject listed below on his/her last report card:    
  Reading      English     Social Studies/History  

   Math      Spelling     Science 		   
  Social/Emotional:        
  **Has the applicant ever experienced any social, emotional or disciplinary problems at other preschools/schools?    
  No   Yes    If yes, please explain    
  **Does your child tend to be: Outgoing     Shy    Withdrawn    
               
  Emergency Care Information    
  Name of child's doctor   Office Phone    
  Address    
  Name of child's dentist    Office phone    
  Address    
       
  If neither father nor mother(or guardian) can be contacted, call:    
  Name    Relationship    
  Home Phone  Cell Phone  Work Phone    
       
  Name    Relationship    
  Home Phone  Cell Phone  Work Phone    
  If you cannot come for your child, please give the names of persons to whom the child can be released:    
     
     
       
  I agree that the school may authorize the physician of his/her choice to provide emergency care in the event that neither I nor the family physician can be contacted.    
       
  Signature of Parents________________________________________________ Date__________________    
       
  I have received and read the Student Handbook and I will abide by all policies, rules and regulations therein.    
  Click Here for Student Handbook    
       
  Father's Signature__________________________ Mother's Signature______________________________    
  Date___________________________    
       
 
After completing this form, please click the PRINT button below .
Sign and mail the printed document to:

Fayetteville Street Christian School
151 W. Pritchard Street
Asheboro, N.C. 27203
    

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