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Application for Admission
Home
Application for Admission
My child is applying for grade
Family Information
Child's Full Name
Gender
Male
Female
Child's Preferred Name
Date of Birth
Parent/Guardian
Relationship to child
Home Address
City, State, Zip
Occupation
Employer
Phone #1
Phone #2
Email
Parent/Guardian
Relationship to child
Home Address
City, State, Zip
Occupation
Employer
Phone #1
Phone #2
Email
Please list the names of sibilings and others living with your child in the home.
Name
Age
School/College
Grade/Level
Child's Previous Education
Name of School
City/State
Dates attended
Grades attended
Name of School
City/State
Dates attended
Grades attended
Name of School
City/State
Dates attended
Grades attended
Other Information
Child's Activities (hobbies, sports, other)
Artistic/Musical interest
What language is spoken at home
What role does media (TV, Movies, Videos, Computer Games, etc.) play in your family life?
Please indicate the number of hours viewed daily and on weekends:
TV
On weekends
Movies/Videos
On weekends
Computer/Video Games
On weekends
What do you consider your child's strongest aptitudes and traits of character?
What traits would you especially like to see strengthened?
Share with us any information you feel we should know about your child or your family.
Please list any health conditions and medications your child in taking.
Signature of Parent/Guardian
Date
Signature of Parent/Guardian
Date
Consent to Release Student Records to Pace Waldorf Academy
To:
Address
The undersigned gives you permission to furnish information to the Pace Waldorf Academy on the undersigned student. This student either has enrolled or intends to enroll in Pace Waldorf Academy. Previous schools and/or Physicians are asked to provide all health records, behavioral records, withdrawal grades, dates of attendance or treatment, evaluations, and all achievement scores.
I Agree
Child's name
Current Grade
Parent/Guardian Printed Name
Parent/Guardian Signature
Date Requested
Records should be faxed or mailed to:
Pace Waldorf Academy
16698 Lantana
Harlingen, TX 78552
956-778-4295 voice
956-361-5556 fax
