Elementary/Middle School Application

NEW HOPE CHRISTIAN SCHOOL

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Class applying for:

For School Year:

Optional services:

Afterschool Care ($50/mo.)

First Name

Last Name

Address

City/Zip

Current Age

Gender

Birthday

Birth Place

Ethnicity

Language spoken at home

Physician's Name

Phone

Address

City/Zip

Ongoing/recurrent Medical Conditions

Allergies

Medications (list names)