Beruflich Dokumente
Kultur Dokumente
Our Mission:
Excellence in education in a safe, positive, Christian environment
To be like Jesus as described in Luke 2:52
And Jesus increased in wisdom, stature, and in favor with God and man.
(Intellectually, physically, spiritually, and socially)
GENERAL INFORMATION
Students Name _____________________________________________________________________
Last
First
Middle
Goes By
Male
Current Address_______________________________________________________________________
Street
City/State/Zip
Ethnicity of Student
Anglo-Saxon
Asian/Pacific Islander
Students Social Security Number _______________________
African American
Students Cell Phone Number __________________________
Hispanic
School Attending or Last Attended ______________________
Indian (American/Alaskan)
Address ______________________
Students School District ______________________
*Updating information such as change in phone #, address, & email is very important. Update forms are
available in the front office. You may also update contact information on Jupitergrades.
Fathers Name ___________________________
Mothers Name___________________________
Cell Number_____________________________
Mothers E-mail___________________________
Address ________________________________
Address ________________________________
Occupation___________Phone _____________
Occupation _____________Phone___________
Note: Parents seeking to limit the right of another parent to school-related information or to pick up a child or visit
with a child or remove a child MUST present the school with current and valid orders. Please check all that apply
a copy of such orders must be on file in the office:
Court Orders
Restraining Orders
Custody Orders
Modifications
No Legal Documents
Has your child previously attended WMCS?
Yes or
Please list other adults and children living in the household and indicate the relationship to the enrolling student.
(Please list the ages next to children aged under 18 years old)
_____________________________________________________________________________________
Are any of these children currently enrolled at WMCS? Yes or No
MEDICAL INFORMATION (Please check any of the following conditions that apply to your child.)
______ Convulsive Disorder ______ Diabetes
_______ Visual Problem ______ Hearing Problem
______ Orthopedic Disability ______Heart Problem _______ Asthma
______ Attention Deficit Disorder
Additional health problems or comments:
___________________________________________________________________________
My child is allergic to ___________________________________________________________________
What type of reaction?____________________________________________________________
Does your child take medication on a regular basis?
Yes
No
If yes, explain ________________________________________________________________________________
Yes
No
Yes
No
How many days has your child been absent this school year?______
______________
Yes
Yes
Yes
Yes
No
No
No
No
Please make a full statement as to why you want to enroll your child at WMCS.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Please share how you integrate your faith in your family.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
FINANCIAL INFORMATION
Name of Responsible Party for tuition____________________________________________________________
Full Name
Relation to Student
Address ___________________________________________________________________________________
Street
City
State/Zip
Phone ____________________________________________________________________________________
Home
Work
Cell
WMCS utilizes the services of SMART TUITION (www.smarttuition.com) to bill and collect tuition and fees. Upon
acceptance into WMCS, every family must set up their account with SMART TUITION. The fee to set up is $45 and
will be waived if a family pays in advance for one year.
How did you find out about WMCS?
Referred by WMCS Family Whom may we thank for their referral? _______________________
Attended WMCS - Which years? Did you graduate from WMCS? If so, what year? ___________
Local Realtor Realtors Name _______________________________
Internet Advertising
Chamber of Commerce
Newspaper Articles
Other
__________________________________________
Mothers Signature
Date
___________________________________________
Students Signature
Date
Nondiscrimination Statement:
West Memphis Christian School admits students of any race, color, national and ethnic origin to
all the rights, privileges, programs, and activities generally accorded or made available to
students at the school. It does not discriminate on the basis of race, color, national and ethnic
origin in administration or its educational policies, admissions policies, scholarship programs,
and athletic and other school-administered programs.
I certify that, to the best of my knowledge, the information contained in this application is true, accurate, and
complete:
_________________________________________
Signed
____________
Date
OFFICE USE
Date Received:
Check #
Date:____________