Maranatha Seventh-day Adventist Christian School
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NOTE: Please fill out a separate application for each child applying for admission.                                                            1. ________________________
2. _________________________________________________________ 3. ____ 4. ____ 5. ____________ 5a. ____________ 6. _____________
            Last                                         First                                                         Middle                                Grade              Sex               Mo./Day/Yr.                              Years/Mos.                          Date Baptized in
                                                     Child’s Full Legal Name                                                                              Entering                                    Birthdate                                 Age                                SDA Church
7. Place of Birth_________________________ (Country)         8. Ethnic Origin (check one) Caucasian ___ Black ___ Hispanic ___ Oriental ___                                                           Am. Indian ___ Other _______________________ (Specify)
(For Federal Government and General Conference purposes only)

Legal name of parent or guardian with whom pupil is living:
Church Mbr Where?
Home               Business
Home Address
9.    Father:
10. Mother:

In case of accident or serious illness, if the school is unable to contact me, I hereby authorize the school to take my child to the physician, emergency room and/or to the relative or neighbor indicated below:
11. _______________________________________________________________________________________________________________________
            Doctor’s Name                                                                                                        Phone                                                      Address
12. _______________________________________________________________________________________________________________________
            Neighbor’s or Relative’s Name                                                                                                Phone                                                      Address

13. Brothers and Sisters
Birth Date

14. I agree to see that this student’s tuition is cared for monthly.
15. I agree to cooperate with the school board and teachers by avoiding adverse criticism of any teacher or school policies in the presence of students.
16. I have read the school policy book and agree to support each regulation of the school, written and oral.
17. I hereby authorize the school to send, upon request, the permanent records to the next school to which my child may enroll.
18. ____________________________________________________________ (Signature of Parent or Guardian for the above #11 through #17 agreements)
Make copies for cumulative folder, principal and teacher
C:\Documents and Settings\Owner\My Documents\Red Book\Application for Admission.doc