Online Application : Echo Ridge Christian School Nevada City CA

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Online Application

Student First, Middle, and Last Name

Grade applying for

Date of Birth

Place of Birth

Sex

Male
Female

Current Grade

Last School Attended

School Address

Phone or Fax Number

Student Lives with

Mother
Father
Step-Mother
Step-Father
Guardian
Other

Home Address

Mailing Address (if different)

Email address where school correspondence can be sent

Home Phone

Cell Phone

Alternate

Names of Legal Parents/Guardians

Name, address, and email of person to whom financial stements should be sent, if different from above

Is Parent/Guardian a Seventh-day Adventist?

Yes No

Location of Church Membership (if any)

Language/s Used at Home

Is student sponsored by an SDA church member?

Yes No Unsure

Is student a member of SDA church

Yes No

If yes, year baptized

Location of church membership

Does student have an unpaid account at another SDA school?

Yes No

If so, where?

Why do you believe Echo Ridge Christian School is a good fit for your child?

What are your child's unique needs and interests that you think we should know about to help them thrive at ERCS?

Does student have a current IEP (Individual Education Plan)?

Yes No

If yes, under what eligibility?

Has student ever been diagnosed for a learning disability, dyslexia, ADD/ADHD, or other special needs?

Yes No

If yes, please explain

Has student ever been placed in a special education classroom?

Yes No

Does your child have any other special learning, social, physical, or emotional needs of which the school should be aware or plan accommodations?

Yes No

If yes, please explain

Does student have any special health needs or alergies?

Yes No

If yes, please explain

Does student take daily medications

Yes No

If yes, please explain

Indicate any physical problem(s)

If other, state here:

Family Physician

Address

Phone

Person to be notified in case of an emergencies

Relationship to child:

Address

Phone

Where did you hear about Echo Ridge Christian School?

Friend
Relative
Website
Web Search
Brochure
Community Event
Other

If Community Event or Other, please let us know which