Katherine Michiels School Application

ELEMENTARY APPLICATION FOR ENROLLMENT

(One application per child)

Child Info:
Child's Name: Gender: Birthdate:
Address: City: Zip:
Ethnicity: Email:
Parents are:

Parent/Guardian 1:
Name: Age: Email:
Home Phone: Cell Phone:
Address: How long? Do you?
Occupation: Salary: How Long?
Name of Employer: Work Phone:
Employers address:
Drivers License #: Social Security #

Parent/Guardian 2:
Name: Age: Email:
Home Phone: Cell Phone:
Address: How long? Do you?
Occupation: Salary: How Long?
Name of Employer: Work Phone:
Employers address:
Drivers License #: Social Security #

Details:
List other children's names and ages:
I would like to enroll my child in KMS beginning:
Previous school: Location:
How long at previous school?
Please list any important information about your child’s previous school experience that would be helpful to us:
(Include any special test results, etc.)

Health:
Physician: Phone Number:
What communicable diseases has your child had? Measeles: Mumps: Chicken Pox:
Other (Specify)
Any serious illness or hospitalization? (Explain)
Any physical Disabilities? (What?)
Any known allergies? (Please list)
Any medications given regularly? (What/How often?)
Any special needs? (Explain)

Parent/Teacher Information
What are your educational priorities for your child?
Why have you chosen KMS?
How did you hear about KMS?

Parent Participation:

We like our parents to be involved in the care and schooling at KMS.

To what extent and how often would you be able to participate in/with:
Parent Committees:
Special Events:
Visiting and spending time at KMS during the day:
Donations, fundraising, other volunteer interests:
Comments:

Financial Aid:
Do you need financial aid: How much of the tuition could you pay?

Payement / Completion:
How would you like to payment KMS the $75 application fee?
Sender Name: Relation to child:
(Payment completion on next page)