New Student Application
1490 N.W. Flamingo Road Plantation, Florida 33323 |
Check # _______ $ _________ |
Phone (954) 723-1520 / (954) 472-5750 FAX: (954) 472-1295 / (954) 723-1528 |
Interview Date: ____________ |
All Information must be provided for this application to be considered. Application fee is $20.00 |
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Student Information: |
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| Date child will enter BCS: | Applying for grade: | |
| Child's legal name: | ||
| Last |
First |
Middle |
| Child's Birth date: | Sex: | Birthplace: |
| Child's Permanent Address: (Street) |
| City: | Zip: | Subdivision: |
| Parent Information: | ||
| Natural Father Stepfather | Natural Mother Stepmother | |
| Other | Other | |
| Name: | Name: | |
| Birth date: | Birth date: | |
| Social Security Number: | Social Security Number: | |
| Address: | Address: |
| City: Zip: | City: Zip: | |
| Home Phone: | Home Phone: | |
| Cell Phone: | Cell Phone: | |
| Business Phone: | Business Phone: | |
| Business Name: | Business Name: | |
| Occupation: | Occupation: | |
| Parent's marital status: | Parent's marital status: | |
| Academic Information: |
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| School student attended: |
| Address:
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| Phone: | Please submit the most recent report card. | |
| Has your child been retained in any grade?
yes no |
Which grade? | |
| Has your child ever been placed in a learning reinforcement or disability
class at any level?
yes no |
| If yes in what subject area(s)?: |
| Has your child ever been placed in an honors program? | yes no | |
| If yes, in what subject area(s) and what grade(s)?: |
| Has your child ever been suspended?
yes no |
expelled?
yes no |
asked to withdraw?
yes no |
| If yes, please explain the situation and give the principal's name and the address of the school. |
| Why is your child withdrawing from his present school?: |
Describe your child's interests, talents, abilities: |
| Where did you receive information about LA VILLA Christian School? |
| Why do you want your child to attend LA VILLA?: |
Father's Signature_______________________________ Date: _________________________
Mother's Signature ______________________________ Date: _________________________