Enrollment Application

Your Name (required)

Your Email (required)

Subject

Child Name (Last, First, Middle):

Child Date of Birth: Present Age:

Grade to Enter:

Social Security Number:

Address: Zip Code:

Phone: Cell: Text?

Last School Attended: Address:

Where would student be attending if not Westfair?

Have you ever been a student at Westfair? When?

**********

Student's Physician: Phone:

Any physical defects? If Yes, explain:

**********

Church you currently attend: Address:

Pastor's Name: Phone:

**********

Parental Status:

Father's Name:

Father's Employer: Phone:

Father's Email Address:

Mother's Name:

Mother's Employer: Phone:

Mother's Email Address:

Emergency Contact: Phone:

Relationship:

**********

Reason for choosing Westfair:

Academic level of student work:

Has child had any disciplinary problems? If Yes, explain:

Has child been expelled, suspended, or refused admission to another school?

If Yes, explain:

Is child now or ever been under the supervision of a parole officer or under the custody of the court?

If Yes, explain:

If transferring from another school, are all accounts paid?

If No, how much is still owed?

STATEMENT OF COOPERATION

In making application, I agree to support all school policies and insist that my child submit to all regulations and requirements, both academic and disciplinary. I understand that no refunds are made on registration fees and if payments are not being made to the school, my child may be dropped from the program. I also give permission for my child to participate in all school activities, including sports and school-sponsored trips, and absolve the school from liability to me or my child because of any injury to my child at school or during any school activity.

Date: Parent/Guardian Signature:

MEDICAL PERMISSION

By signing below, we hereby give the school our permission to give our student(s) non-aspirin pain reliever or cough drops when needed. If it is of a more serious nature, the office will call.

Parent/Guardian Signature:

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