Parent/Guardian*

Telephone*

Email*

Add Remove

Child's name*

Grade*

1. Please describe your relationship to the Lord Jesus Christ (parent 1).*

1. Please describe your relationship to the Lord Jesus Christ (parent2 ).

2. Are both parents in agreement on enrollment?*

Yes

3. Are you a member of any church?*

Yes

4. Please explain your reasons for choosing CRCS as the educational choice for your student.*

5. What is your perspective concerning the school’s responsibility in disciplining and guiding your child?*

6. Will your child have any difficulty communicating in English?*

Yes

7. Has your child ever been referred for a developmental or academic evaluation?*

Yes

If YES to question #7, please provide details below

8. Has your child been sent to a principal, director, or guidance counselor for previous disciplinary problems?*

Yes

9. Why did you withdraw your child from your last school?*

Please fill out the “Permission to Release Information” form in the Registration Packet.

QUESTIONS 10 - 14 (KINDERGARTEN - 6TH GRADE ONLY)

10. Has your child ever been suspended, dismissed, or denied reenrollment from an educational or extended care program for academic, disciplinary, or other reasons?*

Yes

11. Has your child experienced any of the following academic accommodations?

Tutoring*

Yes

Modification of grading scale*

Yes

Modification of work load*

Yes

Special classroom accommodations (oral testing, extended time)*

Yes

12. Does your child have a history of:

ADD, ADHD (copy of diagnosis by a licensed psychologist or physician must accompany application)*

Yes

Learning Disability (copy of testing and Individual Education Plan must accompany application)*

Yes

Physical Disability (copy of Individual Education Plan must accompany application)*

Yes

Other, please indicate*

13. Has your child ever repeated a grade level?*

Yes

If yes, which grade and for what reasons.*

14. Has your child received a physical, visual, and hearing examination in the last year?*

Yes

If so, please give results.*

Students with academic difficulties applying for admission to Calvary Road Christian School must supply all confidential records, present school records, and any educational evaluations before the admissions process can proceed.

I acknowledge that I have accurately completed the Family and Student Questionnaire and have supplied all records, evaluations, IEP’s and other information if applicable. I understand that by omitting any information, or falsifying of documents, I am jeopardizing my child’s acceptance or continued enrollment.

I agree to the terms and conditions mentioned above.

Note: please click SUBMIT before proceeding to the next section

Calvary Road Christian School Parent Resources

Family and Student Questionnaire

Family and Student Questionnaire

Non-Discriminatory Policy