Preschool through Sixth Grade Application for Admission APPLICATION FORM - COMPLETE FOR PRESCHOOL - SIXTH GRADE Section 1: Student and Schedule Information Application Date:* Month Day Year Name* First Middle Last Student Contact Phone Number*Birth Date:* Month Day Year Age:*Gender:* Male Female Grade Entering:* PK3 PK4 K5 1 2 3 4 5 6 Semester:* Fall Spring Schedule Desired:* Full-time (M-F, 8:20-3:20) Part-time (PK3 or PK4 only) Part-time Select – MWF, 8:20-3:20 Part-time Select – TTh, 8:20-3:20 Part-time Select – M-F, 8:20-1:20 Please list any childcare facilities or schools this child has attended. School:Length of Attendance:Address:School:Length of Attendance:Address:School:Length of Attendance:Address:Has this child been on an IEP while attending any school?* Yes No Has this child been suspended or expelled from any childcare facility or school?* Yes No If yes, please explain.* Section 2: Church Information Home Church:*Pastor:*Phone:*Address:How regularly does your family attend?* Weekly Twice per Month Monthly Section 3: Guardian Information Last Name:*First Name:*Middle Name:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employer:*Email:* Home Phone:*Work Phone:*Cell Phone:*Relationship to Student:* Father Mother Step-Father Step-Mother Grandfather Grandmother Legal Guardian Does the student live primarily with this guardian?* Yes No Should this guardian receive report cards and other student documents?* Yes No Last Name:*First Name:*Middle Name:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employer:*Email:* Home Phone:*Work Phone:*Cell Phone:*Relationship to Student:* Father Mother Step-Father Step-Mother Grandfather Grandmother Legal Guardian Does the student live primarily with this guardian?* Yes No Should this guardian receive report cards and other student documents?* Yes No Section 4: Emergency Information Emergency Contact (if parent/guardian cannot be contacted): Name:*Relationship:*Primary Phone:*Secondary Phone:*Family Doctor:*Phone:*KC Area Hospital Preference:*Health Insurance Company:*Policy Number:* Section 5: Transportation Information Please list the name(s) of any person(s) you wish to authorize to transport this student. Transportation Name:Transportation Name: Section 6: Referral Information Please list the name of the person or family who referred you to Overland Christian Schools. Reference Name:Reference Name: Section 7: Agreements I agree to the following, check boxes. I understand that I am responsible for the payment of my child’s school expenses and that OCS will not release student grade reports if the account is not in good standing.* I understand that I am responsible for the payment of my child’s school expenses and that OCS will not release student grade reports if the account is not in good standing.*I will insist that this student complies with all the rules of OCS.* I will insist that this student complies with all the rules of OCS.*I hereby authorize Overland Christian Schools or its representatives, to photograph, digitize, or otherwise preserve in permanent form my child’s likeness and/or image as well as an example of my child’s academic works. I agree that any such likeness may be used and reused in whole or in part for multimedia productions, Internet distribution, illustration, promotional purposes, and/or educational distribution as deemed fit by Overland Christian Schools, in perpetuity, throughout the world. I also understand that once my child’s image is posted on the OCS website, the image can be downloaded by any computer user internal or external to the school. Therefore, I agree to indemnify and hold OCS harmless from any claims. I also release OCS and its officers, agents, faculty, and emu0002ployees from any and all claims based on my child’s likeness or use of likeness of such and agree to hold OCS harmless from any and all claims by third parties, including any claim based on allegation of copyright infringement from his or her likeness.* I hereby authorize Overland Christian Schools or its representatives, to photograph, digitize, or otherwise preserve in permanent form my child’s likeness and/or image as well as an example of my child’s academic works. I agree that any such likeness may be used and reused in whole or in part for multimedia productions, Internet distribution, illustration, promotional purposes, and/or educational distribution as deemed fit by Overland Christian Schools, in perpetuity, throughout the world. I also understand that once my child’s image is posted on the OCS website, the image can be downloaded by any computer user internal or external to the school. Therefore, I agree to indemnify and hold OCS harmless from any claims. I also release OCS and its officers, agents, faculty, and emu0002ployees from any and all claims based on my child’s likeness or use of likeness of such and agree to hold OCS harmless from any and all claims by third parties, including any claim based on allegation of copyright infringement from his or her likeness.*I authorize Overland Christian Schools to transport this student to and from school-approved off-campus events such as, but not limited to field trips, community service activities, and sports events.* I authorize Overland Christian Schools to transport this student to and from school-approved off-campus events such as, but not limited to field trips, community service activities, and sports events.* Sign & Date Form SignatureDate MM slash DD slash YYYY
