STUDENT APPLICATION
Print out this application, complete in ink and
mail completed application to :
LAKE SHORE CHRISTIAN ACADEMY
860 Swift Road
Pasadena, Maryland 21122
Phone: 410-437-3529
Term: 20______________ Date:_________________
STUDENT INFORMATION
Name________________________________________________________
(Last) (First) (Middle)
Address___________________________________________
City________________________________________ Zip_____________
Telephone_____________________________________________________
Age_______ Sex_____ Birth Date____________ Birthplace_______________
School Last Attended_______________________________________________
Address__________________________________________________
________________________________________________________
Last Grade Completed______________________________________
FAMILY INFORMATION
Father's Name ___________________________________________
Employment_____________________________________________
Position______________________ Business Phone______________
Mother's Name __________________________________________
Employment_____________________________________________
Position ______________________ Business Phone______________
Emergency Phone Number
other than those already listed _______________________________
Marital Status: Married __________ Widow______________
Divorced__________ Separated____________
Children in family of school age if not applying:
Name________________________________ Age____________
________________________________ ____________
________________________________ ____________
Reason they are not applying:_______________________________
_____________________________________________________
RELIGIOUS INFORMATION
Church Attending________________________________________
Address_______________________________________________
Pastor________________________ Phone___________________
Father: Christian ? Yes______ No___________
Mother: Christian ? Yes______ No___________
Has applicant ever made a profession of faith in Christ ?
Yes_________ No________
MEDICAL INFORMATION
Family Physician___________________________________________
Phone___________________________________________________
Does student haveany physical defects or allergies? _________________
Explain:___________________________________________________
Has student received immunizations: Diptheria___________________
Smallpox___________________
Polio ____________________
SCHOLASTIC INFORMATION
Has student ever been expelled, dismissed, suspended, or refused
admission to another school ?____________________________
If yes, explain:________________________________________
Has student ever had a disciplinary difficulty at school?__________
If yes, detail:__________________________________________
Does student have a juvenile or arrest record?_________________
If yes, explain: _________________________________________
Has student ever used tobacco or nonprescription drugs of any kind?
If yes, explain:___________________________________________
Please indicate academic level of students previous work :
Excellent______ Good______ Average________ Poor________
Has student ever failed an academic subject in school?___________
If yes, explain_________________________________________
GENERAL INFORMATION
How did you hear about this school ?________________________
Reason for selecting this school_____________________________
____________________________________________________
Application must be filled out completely before it can be processed.
Application, Registration, and Testing Fees of $_______________
must accompany application and are not refundable.
An interview with the parents and the student will be required before
final acceptance.
For your convenience in meeting your financial obligations, tuition is
divided into ten installments. The first payment is due on or before
____________; the tenth payment is due on ______________
before the final Progress Reports are mailed at the end of the school
year.
"I hereby pledge to pay my financial obligations to the school on the
date due and understand that it may be necessary to withdraw my
student if proper arrangements are not made on a past due account.
"I give permission for my student to take part in all school activities,
including sports and school-sponsored trips away from the school
premises, and absolve the school from liability to me or my student
because of any injury to my student at school or during ant school
activity.
"I agree to uphold and support the high academic standard of the
school by providing a place at home for my student to study and
giving my student encouragement in the completion of any home-
work or assignments.
"I appreciate the standards of the school and do not tolerate profanity,
obscenity in word or action, dishonor to the Godhead and the Word
of God, or disrespect to the personnel of the school. I hereby agree to
support all regulationsof the school in the applicant's behalf and
authorize this school to employ discipline as it deems wise and
expedient for the training of the student.
" I understand that the school reserves the right to dismiss any student
who fails to comply with the established regulations and discipline or
whose financial obligation remains unpaid.
" I have read the Student Handbook, and understand the terms stated
on this Application and agree thereto."
__________________________ _________________________
Signature of Father Signature of Mother
_________________________ ________________________
Date Date