11 Application Packet.docx
- 文档编号:8983875
- 上传时间:2023-05-16
- 格式:DOCX
- 页数:27
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11 Application Packet.docx
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11ApplicationPacket
2010-11ApplicationPacket
CurrentStudentChecklist
_____StudentProfile(entergradelevel,indicatechangesinred,andsign)
_____AdmissionsPolicy
_____Parent\SchoolContract
_____StatementofAcademicResponsibility/CodeofHonorableConduct(Grades4th-12th)
_____AcceptableUsePolicyforInternet
_____ParentalConsentFormforWebsite
_____ParentalConsentforDrugScreening(Grades7th-12th)/DrugScreeningProcedure
_____FeeSchedule(*ApplicationFeeduewithApplicationPacket)
_____Copyof:
∙Updatedimmunizationrecord(ifschooldoesnothavealready)
NewStudentChecklist
_____ApplicationforAdmission(completedandsigned)
_____AdmissionsPolicy
_____Parent\SchoolContract
_____StatementofAcademicResponsibility/CodeofHonorableConduct(Grades4th-12th)
_____AcceptableUsePolicyforInternet
_____ParentalConsentFormforWebsite
_____ParentalConsentforDrugScreening(Grades7th-12th)/DrugScreeningProcedure
_____FeeSchedule(*ApplicationFeeduewithApplicationPacket)
_____ParentInterviewPK/K;Parent\StudentInterview(1st-12th)
_____COPIESOFMANDATORYDOCUMENTSNEEDEDAT
APPLICATIONAPPOINTMENT:
∙_____currentandpreviousreportcards
∙_____standardizedtestscores(Stanford,Iowa,Leap,etc.)
∙_____disciplinaryrecords
∙_____birthcertificate
∙_____immunizationrecord
∙_____socialsecuritycard
_____PK&NewKonly-classroomobservationorOpenHousevisit
(UnlessoldersiblingattendedPKorKatHBCS)
Uponreceiptoftheapplicationpacketandfee,atestingdatemaybescheduledifindicatedbyeducationalrecords.
HighlandBaptistChristianSchool
708AngersStreet
NewIberia,La.70563
Phone:
337-364-2273
Fax:
337-369-6303
www.hbcsni.org
HowhaveyouheardaboutHighland?
___Billboards___Newspaper___Radio___Television
___Friends___Internet___Other:
_____________________
HighlandBaptistChristianSchool
Student'sName:
___________________________________________________________________________Gender:
__________
LastFirstMiddle
EnteringGradeLevel:
_____________DateofBirth:
_________________SSN:
_______________________Race:
______________
HighlandBaptistChurchMember:
YesNoOtherChurchAffiliation:
__________________________________
Grade(s) SchoolAttended Repeated(YorN)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Hasyourchildeverbeensuspendedorexpelledfromanyschool?
Yes_______No__________
Doesthestudenthavingamedicaldiagnosisthatmayaffectlearning?
___________________________________________________
Hasstudenteverreceivedanytypeofspecialeducationservices?
(suchasspeechtherapy,assistancefromresourceteacher,IEP,
behaviorplan,counseling,gifted/talented,etc.)_______________________________________________________________________
____________________________________________________________________________________________________________
PKandnewkindergartenstudentsonly:
ParentsmustcompleteaclassroomobservationorattendOpenHousebeforeapplicationissubmitted.
DateObserved:
______________________AttendedOpenHouse:
Yes_______No______
*Schoolinformationismailedonlytothedomiciliaryparent.Pleaseprovidelegaldocumentation.
Domiciliaryparent:
___bothparents___mother___father___guardian
2010-11ApplicationforAdmission
Father'sName:
LastFirstMiddle
Address:
____________________________________________________________________________________________
City,StateZip
HomePhone:
_____________________MobilePhone:
___________________________Pager:
___________________
EmployerName:
________________________________________________________JobTitle:
______________________
BusinessPhone:
___________________Ext.________Fax:
_____________E-Mail:
_____________________________
ChurchAffiliation:
________________________________Allowedtopickupchild:
□EmergencyContact:
□
Mother’sName:
LastFirstMiddle
Address:
____________________________________________________________________________________________
City,StateZip
HomePhone:
________________________MobilePhone:
___________________________Pager:
___________________
EmployerName:
________________________________________________________JobTitle:
______________________
BusinessPhone:
___________________Ext.________Fax:
_____________E-Mail:
_____________________________
ChurchAffiliation:
___________________________________Allowedtopickupchild:
□EmergencyContact:
□
Guardian:
Name:
_______________________________________________________________Relationship:
____________________
Address:
____________________________________________________________________________________________
City,State,Zip
HomePhone:
________________________MobilePhone:
___________________________Pager:
___________________
EmployerName:
________________________________________________________JobTitle:
______________________
BusinessPhone:
___________________Ext.________Fax:
_____________E-Mail:
_____________________________
EmergencyContacts(EmergencyContactsotherthanparents)
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
PickupInformation…….InadditiontoEmergencyContacts,othersauthorizedtopickupyourchildfromschoolare:
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
ContactName:
__________________________________________________Relation:
____________________________
HomePhone:
__________________________BusinessPhone:
___________________MobilePhone:
________________
MedicalInformation
Physician:
______________________________________________PhoneNumber:
______________________________
Dentist:
_______________________________________________PhoneNumber:
______________________________
Hospital:
______________________________________________PhoneNumber:
______________________________
Doesthestudentsufferfromanymedicalconditionorchronicillnesses?
□yes□no
Ifso,pleasename:
____________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Isthestudentallergictoinsectbites,beestingsorantbites?
□yes□no
Listanyotherknownallergies:
___________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Doesthestudenthave:
Diabetes?
□yes□noAsthma?
□yes□noEpilepsy?
□yes□no
Doesthestudenthaveanyconditionwhichmayrequirefrequentrestroombreaks?
□yes□no
Statereason:
______________________________________________________________________________________________
Listanyothersignificanthealthinformationregardingyourchild:
________________________________________________________
___________________________________________________________________________________________________________
Hasthestudentbeendiagnosedwithahearingimpairment?
□yes□noDescribe:
__________________________________
Doesthestudenthaveavisualimpairment,wearglassesorcontacts?
:
□yes□noDescribe:
___________________________
Willthestudentbetakinganymedicationthroughouttheyear?
□yes□noDescribe:
__________________________________
Ifso,pleasecheckwiththeofficeaboutregulationsonHBCSadministeringmedicationonmedicationadministeredbyHBCS.
Listallmedicationstudentisprescribedtotake:
_____________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Ifyourchildisseriouslyinjuredandschoolpersonnelareunabletoreachanemergencycontact,thefinaldecisionfor
actiontaken
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- 11 Application Packet