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Menu
Registration
Careers
Contact Us
Home
About Us
Services
Registration
Careers
Contact Us
Menu
Home
About Us
Services
Registration
Careers
Contact Us
Student Information
School Calendar
Parent Handbook
Record Release
School Term: 20
Date :
First Name
Middle Name
Last Name
Primary Residence
City
Zip
Telephone
Birthdate
Age
Last Grade Completed
New enrollment – Last public school attended
Address
Student Social Security #
Circle if Applicable: Parents Married / Parents Separated / Parents Divorced / Father Deceased / Mother Deceased
If divorced, who has primary custody? A copy of custody papers must be on file.
Student resides with (Check all):
Father
Mother
Stepfather
Stepmother
Guardian
Grandparents
Family Information
Father’s Name
Employment
Position
Business Phone
Social Security #
Mother’s Name
Employment
Position
Business Phone
Social Security #
Emergency Telephone Number other than those already listed
Email for School Updates:
Please provide the following information of the parent not living with the child:
Full Name:
Spouse’s Name:
Home Address:
Home Phone:
Cell Phone:
Work Phone:
Occupation/Firm Name:
Email Address:
Please send:
No Mailings
All Mailings and Email Communications
List of other people permitted to pick up your child:
Name:
Name:
Name:
Name:
Written or emailed request for your child to leave with someone else must be received by supervisor morning of the requested day.
Religious Information
Church Attending :
Address:
Pastor
Phone
Father: Christian?
Yes
No
Mother: Christian?
Yes
No
Has applicant even made a profession of faith in Christ?
Yes
No
Medical Information
Family Physician
Phone
Does student have any physical defects or allergies?
Explain
Has student received necessary immunizations?
Yes
No
Will medication need to be dispensed at school on a daily basis?
Yes
No
If yes please provide Medical Permission Form and daily medication dispenser.
How could this medicine affect your child in the classroom?
Does applicant have a life-threatening allergy?
Yes
No
If yes, please explain
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Contact Info
239 997 7702
lwcstigerstrong@gmail.com
Living Word Christian School 2900 North Tamiami Trail North Fort Myers, Florida 33903
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School All Rights Reserved. Designed And Developed By
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