Sample Page 1 Student First Name Nick Name Middle Name Last Name Address Date of Birth: Grade applied for: ---1234 for school year: ---20192020 If applying for preschool, please select the number of days desired: ---235 If applying for prekindergarden, please select the number of days desired: ---45 2 Parent/Guardian/Family Name add Primary Phone: Additional Phone(s): Email: Employer: Job Title: Name add Primary Phone: Additional Phone(s): Email: Employer: Job Title: If parents are divorced or separated, who has custody? Stepparents: Applicant's siblings: add Applicant's grandparents: add 3 tbd How did you learn about the Free Union Country School? What are you looking for in a school for your child? Please describe your child's strengths and challenges: What are your child's special interests? If your child has ever been accelerated or held back in school, please dexcribe the circumstances. Does your child have any educational, physical, or emotional needs that we should know about? Please note any previous academic or psychological testing: Person or persons responsible for all fees: Add Address (if not parent) 4 Sign/Submit Parent/Guardian Signatures Parent Date Parent Date Successfully sent! Whatever else..
