Parkside Christian Academy

ADMISSION'S POLICY
Parkside Christian Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students of the school. Parkside Christian Academy will not discriminate on the basis of race, handicap, color, national and ethnic origin in administering its educational policies, scholarship and loan programs, and athletic and other school administered programs.
APPLICATION FEE
After submitting your completed application form online, please mail in the non-refundable registration fee of $100.00 to: Parkside Christian Academy, 215 Forest Hills Street, Jamaica Plain, MA 02130. Applications submitted without this fee cannot be processed. Thank you for your interest in Parkside Christian Academy.

Applicant's Personal Information:
Child's First Name and Middle Initial:
Child's Last Name:
Date of Birth:	month/day/year
Social Security Number:
Gender:
I Wish to Enter My Child in Grade:
For the Academic Year:	20_ _ to 20_ _

Mother's Full Name:
Street address:
City and zip code:
Mother's home phone number:
Mother's cell phone number:
Mother's work phone number:
Mother's place of employment:
Mother's workplace address:	Street address
Mother's workplace address con't:	Cityand zip
Mother's email address:
Father's Full Name:
Street Address (if different from Mother's):
City and zip code:
Father's home phone number:
Father's cell phone number:
Father's work phone number:
Father's place of employment:
Father's workplace address :
Father's workplace address:
Father's email address:
Parents' status:	Check all that apply
Both living:
Mother deceased:
Father deceased:
Marital status:	Specify or check appropriate box
Together:
Separated:
Divorced:
Applicant lives with:	Specify or check appropriate box
Both parents:
Mother:
Father:

SCHOOL INFORMATION:
Name of school child is currently attending:
Name of Principal or Head of School:
School's street address:
City and zip code:
Present grade level:
Date of entry to present school:	month/year
List all school attended during the last three years:
List of school con't:
Has the applicant had any disciplinary problems in school?:	Yes No
If yes, explain:
Is the child currently receiving special education services?:	Yes No
If yes, explain:

CHURCH INFORMATION:
Name of Church/Place of Worship:
Denominational affiliation:
Church's phone number:
Church's Street Address:
Church's address con't:
Pastor's name:

IDENTIFYING INFORMATION :	Required by the Office for Children Regulations
Eye color:
Hair color:
Height:
Weight:
Race/Ethnic background:
Identifying marks:	Please specify

OTHER INFORMATION:
How did you come to know of Parkside Christian Academy?:	Specify or check all that apply
Parkside parent:
Parkside Faculty Member:
Parkside Student:
Alumnae of Parkside:
Pastor:
General Reputation:
Other :
Will you be applying for financial aid?:	Yes No
Name of Person Submitting this Form: