Christian School in Rogers City, Michigan

APPLY NOW FOR THE K-8TH GRADE PROGRAM

Thank you for beginning the enrollment process in the Kindergarten through 8th Grade Program at St. John Lutheran School! The initial paperwork, which can be submitted online by completing the form below, includes the following:

Application for Enrollment

Permission for Use of SJLS Computers and Internet

Photo Release

Concussion Awareness Educational Material Acknowledgement

Written Information Packet Documentation

Ready to Apply?

Please fill out the application form below to apply to St. John Lutheran School!

"*" indicates required fields

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Family Name*

Last

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone*

Family Email*

Church Membership

Please check if this information may be included in a school family directory.*

Street Address:

Home Phone:

Family Email

Church Membership

None of the Above

Student Information

Student Name*

First Middle Last

Grade (Fall of Previous Year):*

Birthdate*

Month

Day

Year

Place of Birth:*

City State Country

Date of Baptism:

Month

Day

Year

Baptism Location:

City State Country

Ethnicity:*

Family Information

Single Parent Household?*

Yes

Choose one:*

Single Mother

Single Father

This field is hidden when viewing the form

Father's info

Father's Name

First Last

Father's Address (If different from above):

Street Address City State ZIP / Postal Code

Father's Home Phone (If different from above):

Father's Work Phone

Father's Cell Phone

This field is hidden when viewing the form

Mother's Info

Mother's Name

First Maiden

Mother's Address (If different from above):

Street Address City State ZIP / Postal Code

Mother's Home Phone (If different from above):

Mother's Work Phone

Mother's Cell Phone

Other Children Living at Home

Please list the names and dates of birth.

Name	Date of BIrth	Actions

There are no entries.

Maximum number of entries reached.

Preferred Method of Contact*

Please select one preferred method of contact.

Call to home phone

Call to mother’s cell

Call to father’s cell

Text to mother’s cell

Text to father’s cell

Email to family email listed above

Preschool Schedule

If you are not a preschool parent and this does not apply to you, please check this box:

Check here if not applicable

Preschool parents, please indicate sessions desired for your child:

AM Monday

PM Monday

AM Tuesday

PM Tuesday

AM Wednesday

PM Wednesday

AM Thursday

PM Thursday

AM Friday

PM Friday

NONDISCRIMINATION POLICY:

St. John Lutheran School admits students of any race, color, national and ethnic origin to all the rights and privileges, programs and activities accorded or made available to students at the school. It does not discriminate on the basis of race, color, or national or ethnic origin in administration of its educational policies, admissions policies, scholarships programs, and athletic and other school administered programs.

Permission for Use of SJLS Computers and Internet

As a user of the St. John Lutheran School Computer Network and Internet, I hereby agree to follow the Acceptable Use Policy of SJLS Computers and Internet (CLICK HERE to view) and use the network in a responsible and God pleasing manner for as long as I am a student at St. John Lutheran School of Rogers City, MI.

Student Name*

First Middle Last

Student Grade (entering)*

Student Consent - I agree to the Acceptable Use Policy of SJLS Computers and Internet.

Please sign below:

Date

As the parent or legal guardian of the above student, I grant permission for my child to access the SJLS computers and internet for school related purposes. I understand that under the Acceptable Use Policy of SJLS Computers and Internet (CLICK HERE to view) my student may be held responsible for violations.

Parent or Guardian Full Name*

First Middle Last

Parent or Guardian Consent

I agree to the Acceptable Use Policy of SJLS Computers and Internet.

Date

Photo Release

Website*

I give my permission for my child’s photos (taken during school functions) to be published on the church and school website.

I do not wish to have my child’s picture on the church/school website.

Newspaper*

I give my permission for my child’s photos (taken during school functions) to be published in the local newspapers.

I do not wish to have my child’s picture in the local newspapers.

Parent or Guardian Full Name*

First Middle Last

Student Name*

First Middle Last

Parent Signature*

Date

Parent Comments

Concussion Awareness Educational Material Acknowledgement

By my name and signature below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the Concussion Fact Sheet for Parents and Students (CLICK HERE to view) provided by St. John Lutheran School of Rogers City, Michigan.

St. John Lutheran School must keep this on file for the duration of enrollment/participation and until age 25.

Students and parents should review and keep the educational materials for future reference.

Student Name*

First Middle Last

Student Consent*

I confirm that I have received and reviewed the Concussion Fact Sheet for Parents and Students.

Date

Parent or Guardian Full Name*

First Middle Last

Parent or Guardian Consent*

I confirm that I have received and reviewed the Concussion Fact Sheet for Parents and Students.

Date

Student’s Date of Birth*

Month

Day

Year

Date when student will turn 25 years old*

Month

Day

Year

Report any known previous incident(s) of concussion:

The following form needs to be filled out if you have a pre-school-aged child. If this does not apply to you, please click this box to skip this section.

Skip this section

If this does apply to you, please review the Preschool Handbook (CLICK HERE to view) and complete the following section.

Written Information Packet Documentation Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems

A written information packet has been provided at the time of enrollment. The packet included all of the following information:

Criteria for admission and withdrawal.
Schedule of operation, denoting hours, days, and holidays during which the center is open and services are provided.
Fee policy.
Discipline policy.
Food service program.
Program philosophy.
Typical daily routine.
Parent notification plan for accidents, injuries, incidents, illnesses.
Exclusion policy for child illnesses.
Notice of the availability of the center's licensing notebook.
- The licensing notebook contains all the licensing inspection and special investigation reports and related corrective action plans since May 28, 2010.
- The licensing notebook is available to parents during regular business hours.
- Licensing inspection and special investigation reports from at least the past two years are available on the child care licensing website at www.michigan.gov/michildcare.

Agreement

I certify that I received all of the above items. (Parent or Guardian Signature)*

Date

Admissions

Preschool Program
K-8th Grade Education
After School Care
After School Care Forms and Consents
Summer Splash Childcare Program
Summer Splash Childcare Forms and Consents

APPLY NOW FOR THE K-8TH GRADE PROGRAM

Application for Enrollment

Permission for Use of SJLS Computers and Internet

Photo Release

Concussion Awareness Educational Material Acknowledgement

Written Information Packet Documentation

Ready to Apply?

Student Information

Family Information

Father's info

Mother's Info

Preschool Schedule

NONDISCRIMINATION POLICY:

Permission for Use of SJLS Computers and Internet

Photo Release

Concussion Awareness Educational Material Acknowledgement

Written Information Packet Documentation Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems

Agreement

Admissions

St. John Lutheran School

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