| ESCAMBIA CHRISTIAN SCHOOL
3311 West Moreno Street P. O. Box 17449Pensacola, FL 32522 Phone: 433-8476 |
FOR OFFICE USE ONLY:
_____ REGISTRATION FEE _____ REPORT CARD _____ PHYSICAL _____ IMMUNIZATION RECORD _____ BIRTH CERTIFICATE _____ ENTRANCE DATE |
STUDENT’S NAME ___________________________________________ Male ___Female ___
STUDENT'S SOCIAL SECURITY NUMBER ________________________________________
MAILING ADDRESS ____________________________________________Zip Code________
E-MAIL ADDRESS _____________________________________________________________
PLACE OF BIRTH_______________________________________DATE OF BIRTH _________
TELEPHONE (HOME) __________________CELL) ____________ GRADE TO ENTER ______
FAMILY INFORMATION:
With whom does the child reside:
FATHER/GUARDIAN
MOTHER/GUARDIAN
NAME __________________________________ NAME _______________________________
PLACE OF EMPLOYMENT
PLACE OF EMPLOYMENT
_______________________________________ ______________________________________
WORK PHONE _________________________ WORK PHONE ________________________
Additional individuals permitted to pick up child___________________________________________
_______________________________________________________________________________
IF THIS IS YOUR FIRST YEAR AT ESCAMBIA CHRISTIAN SCHOOL,
HOW DID YOU BECOME ACQUAINTED WITH E.C.S.?
Billboard _________
Bell South Pages _________ Gulf Coast Parent
_________
Friend _____________________________
Other ____________________________
(Name)
(Name)
Church preference ______________________________________________________________
Attend where __________________________________________________________________
Minister’s Name ________________________________________________________________
EDUCATION INFORMATION:
Last School Attended ____________________________________________________________
Years Attended ____ Reason for transferring _________________________________________
School Mailing Address __________________________________________ Zip Code _______
Has Child ever repeated a grade? _________ If so, which one? __________________________
(Admission to a grade is subject to confirmation by records.)
STUDENT HEALTH INFORMATION:
Student’s health is: ( ) Excellent
( ) Good
( ) Fair
( ) Poor
If fair or poor, please explain: ______________________________________________________
_____________________________________________________________________________
Allergies (Medication, Food, Other):_________________________________________________
Does student have any disability that would hinder participation in
normal school activities?
( ) Yes ( ) No
If YES, please explain: __________________________________________
EMERGENCY INFORMATION:
(If parents cannot be contacted, please list the person who should
be contacted.)
Name _____________________________________________________Phone: _____________
Relation to Student ______________________________________________________________
Child’s doctor and phone number __________________________________________________
STATEMENT OF COOPERATION:
I have read and do understand the policy statements regarding payment
of account, returned checks
and refunds. I will cooperate with Escambia Christian School
as it endeavors to provide a meaningful
educational experience for my child.
FATHER/GUARDIAN SIGNATURE __________________________________ Date _______
MOTHER/GUARDIAN SIGNATURE _________________________________ Date ________
ESCAMBIA CHRISTIAN SCHOOL
3311 West Moreno Street
P. O. Box 17449
Pensacola, Florida 32522
EXTENDED CARE REGISTRATION
School hours are 8:00 a.m. to 2:30 p.m. Morning and afternoon
extended care is available.
Morning students may be dropped off from 6:30 a.m. to 7:30 a.m.
Afternoon students may by picked up between 2:45 p.m. and 6:00 p.m.
EXTENDED CARE FEES ARE AS FOLLOWS:
| TwoStudents from | Each Additional | ||
| One Student | the same family | Student | |
| Morning Extended Care only | $ 50.00/month | $ 60.00/month | $10.00/month |
| Afternoon Extended Care only | $ 80.00/month | $100.00/month | $20.00/month |
| Morning and Afternoon Extended Care | $ 90.00/month | $110.00/month | $25.00/month |
Students picked up after 6:00 p.m. will be assessed a fee of $1.00 per minute.
Students dropped off before 6:30 a.m. will be assessed a fee of $1.00 per minute.
Monthly extended care fees are payable in advance and are due on the first of each month.
Non-extended care students of E.C.S. may be placed in extended care
on a drop-in basis for a flat charge
of $4.00 for the morning session and $8.00 for one (1) student and
$10.00 for two (2) students for the afternoon session.
PLEASE REGISTER _______________________________________ GRADE ______
_________ Morning extended care only
_________ Afternoon extended care only
_________ Morning & Afternoon extended care
_________ Drop-In extended care
_________________
_____________________________________
Date Registered
Signature of Parent/Guardian
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