Reenrollment Form

We are excited about what God is going to do this year! Thank you for taking the time to complete this form online. If you have questions, please feel free to email, chrisbelyeu@yahoo.com

Student Information

First Name *

Last Name *

Grade *

Date of Birth *

Age as of September 1 *

Parent Information

Mailing Address *

Email Address

Father

Father Work or Cell Phone

Cell Phone Provider (ATT, Sprint, Verizon, etc.)

Mother

Mother Work or Cell Phone

Cell Phone Provider (ATT, Spring, Verizon, etc.)

Transportation and Pick Up

Who is authorized to pick up your child from school? * Name/Relationship

Who is NOT authorized to pick up your child from school? (if any) Name/Relationship

Emergency Medical Information

Please list any physical conditions, limitations or allergies that your child might possess.

Emergency Medical Policy.

In case of emergency, illness, or accident, the child is given first aid and the parents are notified. If the parents or the child's doctor cannot be located, the child will be taken to the emergency room of your choice. Family of Faith Christian School does not assume responsibility for the payment of hospital, doctor, or ambulance fees.

First Contact Name

First Contact Relationship

First Contact Phone

Second Contact Name

Second Contact Relationship

Second Contact Phone

In the event I cannot be reached to make arrangments for emergency medical care at the time of an accident or illness, I hereby authorize Family of Faith Christian School to take my child to the doctor or hospital listed below or to another doctor.

Family Doctor or Pediatrician

Doctor Phone

Name of Hospital or Emergency Room

Hospital or ER Phone

Health Insurance Company

Policy Holder's Name

Policy Number

ANY PRESCRIPTION MEDICATION requires a doctor's signature and a note from the parent granting permission for school staff to administer the medication.

AUTHORIZATION FOR NON-PRESCRIPTION MEDICATION: The staff of Family of Faith Christian School has my permission to administer the following medication, if needed, to my child.

Tylenol * YesNo

Throat Lozenges * YesNo

Authentication

Other Information or Comments:

I agree that the information contained in this form is accurate to the best of my knowledge and that I am the legal parent or guardian of this student. * I AGREE

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