e-Enrollment Form - Grace Episcopal Day School

Grace Episcopal Day School
Tradition • Character • Excellence • Service
Pre-K3 - 8th Grade
HM_____ ACS_____ Date_______________
Re-Enrollment Form 2014-2015
PK 3 (MTW) ____ PK 3 (5 day) ____ PK 4 (MTW) ____ PK 4 (5 day) ____ T-5 ____
K ____ 1st ____ 2nd ____ 3rd ____ 4th ____ 5th ____ 6th ____ 7th ____ 8th ____
Name of Child _________________________________________________________________________________________
(Last)
(First)
(Middle)
(Name used in class)
Male
Female
Age ________
Date of Birth __________________________________
(Month/day/year)
Home Addresss_______________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Home Phone _______________________ Email for all School Communication__________________________________
Child lives with:
Both Parents
Mother
Father
Other __________________
Who has legal custody?
Both Parents
Mother
Father
Other __________________
I give permission for the inclusion of my address and phone number on a class roster and in a school directory. These
Yes
No
lists will be used exclusively for Grace Episcopal Day School.
Father’s Name ____________________________________________ Email____________________________________
(Please indicate Mr., Dr., Rev., etc.)
Address (If different from above) ___________________________________________________________________
Business Name_________________________________________ Occupation________________________________
Business Phone ________________________________________ Cellular_________________________________
Mother’s Name ___________________________________________ Email___________________________________
(Please indicate Mrs., Miss, Ms., Dr., etc)
Address (If different from above) __________________________________________________________________
Business Name _________________________________________ Occupation ______________________________
Business Phone _________________________________________ Cellular _________________________________
Who is financially responsible for tuition payment:
Both Parents
Mother
Church Membership ______________________________________________
Father
Other____________
Episcopal?
Yes
(This information is necessary for the National Association of Episcopal Schools report.)
No
Child is a: (check)
Re-enrolling Student
Sibling to GEDS Student
Name of Sibling ______________________________
Child of GEDS Alumni
GEDS Alumni Name __________________________
Paternal Grandparent’s Name ______________________________________________________________________
Address ______________________________________________________________________________________
Street
City
State
Zip
Home Phone__________________________ Email___________________________________________________
Maternal Grandparent’s Name ______________________________________________________________________
Address ______________________________________________________________________________________
Street
City
State
Zip
Home Phone_________________________ Email____________________________________________________
May we include grandparents on our mailing and correspondence list?
National Origin: (Optional)
Yes
No
(This information is used for our annual accreditation report.)
African American
Caucasian
Hispanic/Latino
Asian
Native American
Multiracial
Middle Eastern
Other
Does your child have any allergies or medical conditions that require attention?
Yes
No
If yes, please describe __________________________________________________________________________
Emergency Contact Information (other than parents)
Physician _______________________________________________________________________________Phone _______________
Name ____________________________________ Relationship __________________ Phone _______________
Name ____________________________________ Relationship __________________ Phone _______________
Pick Up Information (other than parents, authorized to pick up child from school)
Name ____________________________________ Relationship __________________Phone _______________
Name ____________________________________ Relationship __________________Phone _______________
I understand photographs may be taken of my child. I give permission for Grace Episcopal Day School to use these for
Yes
No
the school yearbook, social networks, and school promotional purposes.
Parent Signature _________________________________________________________ Date ___________________
A typed name with act as the functional equivalent of a handwritten signature.
Grace Episcopal Day School admits qualified students of any race, creed, color, gender, or national origin to all
the rights, privileges, programs, and activities generally accorded or made available to students at the school.
156 Kingsley Ave. Orange Park, Florida 32073 | Telephone: 904-269-3718 | Fax: 904-269-9183 | Email: [email protected]
www.geds.net