Application

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Application Form 2010-2011

Student Information
Name*
FirstLast
Middle*
Preferred Name*
FirstLast
Birthday*
MM
DD
YYYY
Age*
Sex*
- Male
- Female
Home Address*
Street AddressAddress Line 2CityStateZip Code
Phone*
Child Lives With:*
- Both Parents
- Mother
- Father
- Mother & Step-Father
- Father & Step-Mother
- Guardian
- Other
Are Parents divorced?*
- Yes
- No
Who had custody?
May the child be released to the non-custodial parent?
- Yes
- No
May information be released?
- Yes
- No
Grade applying for*
Previous School*
Additional Programs Needed (please check program and days needed)
- B.A.C. – a.m. (7:15-8:00 a.m.)
- B.A.C./E.D. (11:15 a.m. – 3:15 p.m.)
- B.A.C. – p.m. (3:50-6:00 p.m.)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Family Information
Father
Name*
FirstLast
Middle Name*
Preferred Name*
Birth Date*
MM
DD
YYYY
Social Security Number*
E-mail Address*
Home Address (if different from child)
Street AddressAddress Line 2CityStateZip Code
Phone
Occupation*
Employer*
Business Address*
Street AddressAddress Line 2CityStateZip Code
Business Phone No.*
Business E-mail Address*
Cell Phone No.*
Mother
Name*
FirstLast
Middle*
Preferred*
Birth Date*
MM
DD
YYYY
Social Security Number*
E-mail Address*
Home Address (if different from child)
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Occupation*
Employer*
Business Address*
Street AddressAddress Line 2CityStateZip Code
Business Phone*
Business E-mail Address*
Cell Phone No.*
Step-Father
Name
FirstLast
Middle
Preferred Name
Birth Date
MM
DD
YYYY
Social Security Number
E-mail Address
Home Address (if different from child)
Street AddressAddress Line 2CityStateZip Code
Phone
Occupation
Employer
Business Address
Street AddressAddress Line 2CityStateZip Code
Business Phone
Business E-mail Address
Cell Phone No.
Step-Mother
Name
FirstLast
Middle
Preferred Name
Birth Date
Social Security Number
E-mail Address
Home Address (if different from child)
Street AddressAddress Line 2CityStateZip Code
Phone
Occupation
Employer
Business Address
Street AddressAddress Line 2CityStateZip Code
Business Phone
Business E-mail Address
Business Phone
Brothers and Sisters
Name
FirstLast
Age
Present School
Applying to St. John's?
- Yes
- No
Name
FirstLast
Age
Present School
Applying to St. John's?
- Yes
- No
If applicable, please provide information for other people important in this child’s life (e.g. Grandparent, aunt, uncle, friend)
Name
FirstLast
Relationship to child
Address
Street AddressAddress Line 2CityStateZip Code
Home Phone
Work Phone
Name
FirstLast
Relationship to child
Address
Street AddressAddress Line 2CityStateZip Code
Home Phone
Work Phone
Name
FirstLast
Relationship to child
Address
Street AddressAddress Line 2CityStateZip Code
Home Phone
Work Phone
Will this/these person/s be picking up this child from school?
- Yes
- No
Please complete additional information below A copy of your child’s birth certificate and immunization records must be on file in our office before the first day of class.
St. John’s admits qualified students without regard for race, gender, color, nationality or religious affiliation.
CONFIDENTIAL STUDENT INFORMATION
Student's Name*
FirstLast
Date*
Was this child adopted?*
- Yes
- No
If so, at what age?*
Has the child ever consulted a psychiatrist or other professional counselor?*
- Yes
- No
If so, please explain or attach information.*
Has this child even been retained or repeated a grade?*
- Yes
- No
If so, which grade?*
Other than regular school-administered achievement testing, has your child had screening, evaluation or testing?*
- Yes
- No
Please enclose a copy of the results and/or reports.
If so, when? By Whom?*
Does this child have any physical limitations or medical conditions that would affect participation in our daily routine?*
- Yes
- No
Explain:*
What might you tell us about your child that could help the teachers understand him/her better and meet his/her needs more effectively?*
To assist us in accurately reporting the racial/ethnic composition of our students, please check one of the following:*
- Native American
- Caucasian
- Asian/Pacific Islander
- African American
- Hispanic
- Middle Eastern
What is your denomination and/or church affiliation?*
Please check one:*
- My child has my permission to receive Communion at the school Eucharist.
- My child is not to receive Communion at this time but I wish further information from the school chaplain.
- My child is not to receive Communion at the school Eucharist.
Once a month the 1st through 8th grade students, faculty, and staff celebrate the Eucharist, the Episcopal service of Holy Communion. Your child may receive Communion if he or she has been baptized, received Communion instruction, and regularly receives in your Church. By the rubics of the church, no one may receive Communion who has not been Baptized. A student not receiving Communion may come forward with his or her classmates and receive a blessing. If you have any questions or would like Baptism/Communion Instructions for your child, you may contact the school or church office. If available, please furnish a copy of the Baptismal certificate.
Please list the date of baptism and the performing church.*

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St. John's Episcopal School and Child Development Program 5401 N. Brookline Oklahoma City, OK 73112 405-943-8583 FAX 405-943-8584 Email Us!
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Application

Application Form 2010-2011

Student Information

Family Information

Father

Mother

Step-Father

Step-Mother

Brothers and Sisters

If applicable, please provide information for other people important in this child’s life (e.g. Grandparent, aunt, uncle, friend)

Please complete additional information below A copy of your child’s birth certificate and immunization records must be on file in our office before the first day of class.

St. John’s admits qualified students without regard for race, gender, color, nationality or religious affiliation.

CONFIDENTIAL STUDENT INFORMATION

Contact Us!

Driving Directions

Mission

Important Dates

News Announcements and Weather Alerts