Perrine Seventh-day Adventist© School

EDUCATION IS POWER AND POWER IS CHRIST

Application

Student's Name

Date of Birth

Entering Grade Level

Place of Birth

Gender

Male Female

Current Address

Phone Number

Last school Attended

Church Child attends

Denomination

PARENTS INFORMATION

Parent 1

Name

Address

Phone Number

Marital Status

Relation to Child

Parent 2

Address

Phone

Marital Status

Relation to Child

Person to notify in case of emergency

Phone

Factors which may interfere with child's learning HEARING NERVES SIGHT FATIGUE SPEECH NUTRITION HEART EMOTIONAL STATE LANGUAGE OTHER THAN ENGLISH USED IN HOME

Physician to call in case of emergency

If this physician is unavailable, does school have permission to call an alternate?

Yes No

Students will go to and from school

Has student ever been expelled from school

Yes No

If yes, please explain

Transfer Students only

* NOTE: Grade placement of transfer pupils is tentative until official transcripts and records are received from last school.

Last school attended

Address

Phone

Date of last attendance

Grade Completed*

We understand the requirements and regulations of the school and pledge our full cooperation.

Yes No

Student Signature

Parent's or Guardian's Signature

Date

Related Information

Admissions Academics Family Empowerment Scholarship Florida VPK Program McKay Scholarship School Readiness Scholarship Standards of Ethical Conduct Step Up for Students Scholarship Student Handbook Tuition Information and Fees