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
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:
(Last) (First) (Middle)
Grade to Enter: _________________Enrolling for First Time ( )Yes ( )No
Name and mailing address of last school
P.O. Box/Street City State
Phone: ( )_____________________ Fax: ( )______________________
Age: ____________Date of Birth: ___________________Sex: Male ( ) Female ( )
Ethnic Group_____________ Month Day Year