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DILLON CHRISTIAN SCHOOL 2008-2009- Form 3 Please complete this application and return it to D.C.S., accompanied by a $100.00 non- refundable BOOK FEE and a $100.00 non-refundable REGISTRATION FEE, which includes the Activity Fee. The payment of the $200.00 fee will secure your enrollment while the admission committee evaluates required submitted materials. The $200.00 fee will be returned only if your student is not accepted for enrollment. The following information must be submitted or completed for evaluation purposes. The admission committee and Headmaster will make the final decision concerning enrollment of your child, based on these documents. 1. Signed: Completed “APPLICATION FORM”, “STATEMENT OF COOPERATION”, AND (“INTENT TO ENROLL”, grades 5-12 only) 2. A state certified copy of the child’s birth certificate and a copy of the child’s social security #. 3. A copy of South Carolina Certification of Immunization, (K5-12), on or before 1st day of school. 4. Appropriate letters of recommendation-pastor, assistant pastor, youth pastor, teacher, guidance counselor, principal. One or two, as requested by the Headmaster. 5. Parent-Student headmaster conference(1-12). Please list student for whom enrollment is requested: _______________________________________________SS#______________________Date_________ (Last) (First) (Middle) Grade to Enter: _________________Enrolling for First Time ( )Yes ( )No Name and mailing address of last school attended_____________________________________________________________________________ P.O. Box/Street City State Zip Phone: ( )_____________________ Fax: ( )______________________ Age: ____________Date of Birth: ___________________Sex: Male ( ) Female ( ) Ethnic Group_____________ Month Day Year Parent’s Information: Father:______________________________________ Mailing Address: _____________________________________________________________________ P.O. Box/Street City State Zip Home Phone: ( )______________ Cell # ( )_______________ Work # ( )______________ Occupation:__________________________________________________________________________ Mother: ___________________________________________________________________________ Mailing Address: ____________________________________________________________________ P.O. Box/Street City State Zip Home Phone: ( )______________ Cell # ( )_______________ Work # ( )_______________ Occupation:__________________________________________________________________________ Applicant lives with: ( ) Father & Mother ( )Mother Only ( ) Father Only ( ) Father & Step-Mother ( ) Mother & Step-Father ( )Grandparents ( ) Guardian Email Address:_____________________________________________________________________________ If you cannot be reached in case of emergency, list those whom we may contact: Name:_______________________________ Telephone: ____________________________________ Name:_______________________________ Telephone: ____________________________________ DILLON CHRISTIAN SCHOOL 2008-2009- Form 3 I give permission to Dillon Christian School to release my child/children to the following person(s): _____________________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Paternal Grandparents:___________________________________Phone:_______________________________ Mailing Address:______________________________________________________________________________ Maternal Grandparents:__________________________________Phone:_______________________________ Mailing Address:______________________________________________________________________________ Please list siblings of the applicant: Name:______________________________________School Attending:__________________Age:______ Name:______________________________________School Attending:__________________Age:______ Name:______________________________________School Attending:__________________Age:______ Name:______________________________________School Attending:__________________Age:______ Please check the following if they apply to the applicant: ( )Allergies ( ) Asthma ( ) Nosebleed ( ) Daily ( )Medication ( )Reaction to insect bites Explanation:___________________________________________________________________________ *Will he/she need daily medication while at school? ( )Yes ( ) No If yes, written permission and instructions are required and medication will be kept in the office. *Name of Physician:_______________________________________Phone: ______________________ *Does the applicant have any physical or mental handicaps? ( )Yes ( )No If yes, please explain_____ _____________________________________________________________________________________ _____________________________________________________________________________________ *Has the applicant ever failed a grade? ( )Yes ( )No If yes, please explain_______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ *Does the applicant have a learning disability or has he/she been in a class for special needs? ( )Yes ( )No If yes, please explain:_____________________________________________________________ *Please list applicant’s extra curricular interests, abilities, and achievements:_______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ What church does the family attend at this time?____________________ Are you a member? ( )Yes ( )No Why do you wish to send your child to Dillon Christian School?______________________________________________________________________________ _____________________________________________________________________________________ If this information should change at any time, promptly notify the school office. The office needs WRITTEN NOTIFICATION if anyone other than the individuals above is to pick up your child. DILLON CHRISTIAN SCHOOL 2008-2009- Form 3 NOTE: *Hours of School Supervision 7:30 a.m. - 3:00 p.m. *Sports Practice/Games/Extra-Curriculum Activities Supervision 15 minutes before and 15 minutes after school hours ) 1. Returning to the D.C.S. campus after an away game or school activity, the coach or faculty representative will be certain all students have been picked up before leaving the D.C.S. campus. 2) Transportation to away athletic contests will be arranged by the school. Athletes and cheerleaders will ride to and from the game and back to the campus accordingly. The only exception to the rule is that a student’s parents may present a written request to transport their son or daughter following any athletic contest. Parental transportation is the only exception to this rule. Dillon Christian School accepts and reveres the Bible as the holy, inerrant, and authoritative Word of God. We joyfully, and enthusiastically teach and promote the Biblical perspective in all academic subjects and in the general administration of the school. Attendance at Dillon Christian School is a privilege. It is a precious opportunity which by necessity must be upheld by a disciplined code of school regulations. The school administration may at any time request the withdrawal of any student who, in the opinion of the administration, does not submit to the school’s philosophy and/or regulations. DCS has an open admissions policy without regard to race or sex, and will not permit discrimination against any student. The primary goal of DCS is to provide quality education, with a Biblical perspective, in an atmosphere of loving discipline. The person(s) whose signature appears below is responsible for payment and fees outlined in the application and the enclosed Tuition Contract. PARENT SIGNATURE ____________________________________ DATE ______________________________
