Enrollment Form K5-8 | Shining Star Christian Schools

Please complete all applicable sections. Information is kept confidential and used for enrollment, student support, and emergency response purposes. Fields marked with * are required.

1. Enrollment Information

2. Student Information

Student Legal First Name *

Middle Name

Legal Last Name *

Preferred Name

Date of Birth *

Age

Sex *

Primary Language

Home Address *

City / State / ZIP *

Student Email (if applicable)

Student Cell Phone (if applicable)

Does the student reside with both parents/guardians? *

Yes No

If no, explain the living arrangement and identify the person(s) with legal educational decision-making authority:

3. Parent / Guardian Information

Parent / Guardian 1

Full Name *

Relationship to Student *

Home Address (if different)

City / State / ZIP

Primary Phone *

Alternate Phone

Email *

Employer / Occupation

Preferred Communication Method

Phone Text Email

Parent / Guardian 2

Full Name

Relationship to Student

Home Address (if different)

City / State / ZIP

Primary Phone

Alternate Phone

Employer / Occupation

Preferred Communication Method

Phone Text Email

Custody, guardianship, court order, or pickup restrictions the school must know about (attach supporting documents):

4. Emergency Contacts & Authorized Pickup

Contact 1 Name *

Relationship *

Primary Phone *

Alternate Phone

Authorized for Pickup? *

Yes No

Contact 2 Name

Relationship

Primary Phone

Alternate Phone

Authorized for Pickup?

Yes No

Contact 3 Name

Relationship

Primary Phone

Alternate Phone

Authorized for Pickup?

Yes No

The school may request photo identification before releasing a student to an authorized person.

5. Previous School & Academic Information

Most Recent School Attended

School District / City / State

School Phone

Last Grade Completed

Dates Attended

Reason for Leaving

Has the student ever repeated a grade?

Yes No

Has the student ever been suspended, expelled, or asked to withdraw?

Yes No

Does the student currently have an IEP, 504 Plan, gifted plan, ELL plan, or other accommodation plan?

Yes No

Describe the student's academic strengths, areas needing support, accommodations, behavior supports, and any relevant educational history:

6. Health, Medical & Student Support Information

Primary Physician / Clinic

Physician Phone

Preferred Hospital

Health Insurance Provider

Policy / Member ID

Allergies (food, medication, environmental)

Medical conditions, diagnoses, mobility needs, dietary restrictions, medications, mental health or behavioral concerns, or emergency action plans:

Will medication need to be administered during school hours?

Yes No

A separate medication authorization and physician documentation may be required before school personnel can administer medication.

Does the student require an EpiPen, inhaler, seizure plan, diabetes plan, or other emergency medical protocol?

Yes No

7. Transportation, Dismissal & Attendance

Primary Dismissal Method

Parent/Guardian Pickup Authorized Adult Pickup Student Driver Walk/Bike Other

Student Driver applies only where age-appropriate and expressly approved by the school.

Daily transportation instructions, custody exchange details, or special dismissal arrangements:

May the student be released to participate in approved school activities and local field trips with advance notice?

Yes No

8. Technology, Media & Communication Permissions

Technology Use: I authorize my student to use school-approved devices, platforms, internet access, and educational applications in accordance with school policies.

Yes No

Photo/Video: I authorize use of my student's image, voice, or schoolwork for school publications, website, social media, newsletters, and promotional materials.

Yes No

Electronic Communication: I authorize school staff to communicate with the parent/guardian by email, text message, phone, and approved school platforms.

Yes No

Directory Information: I authorize the school to include limited directory information in school programs, yearbooks, rosters, or similar school-related materials.

Yes No

9. Faith-Based Program Acknowledgment

I understand that Shining Star Christian Schools provides a Christ-centered educational environment. Biblical instruction, prayer, worship, character development, and faith-based activities may be integrated throughout the school program. I acknowledge this religious mission and consent to my student's participation in the school's regular educational program.

I acknowledge and agree *

10. Family Information & Enrollment Support

Church / Faith Community (optional)

Pastor / Ministry Leader (optional)

How did you hear about the school?

Sibling(s) Applying or Enrolled

What are your primary goals for your student's education, spiritual growth, and development?

Is there anything else you would like the enrollment team to know?

11. Required Document Checklist

12. Parent / Guardian Certification & Signatures

I certify that the information provided in this enrollment form is true, complete, and accurate to the best of my knowledge. I understand that withholding or misrepresenting material information may affect enrollment. I authorize Shining Star Christian Schools to contact prior schools, educational providers, references, healthcare providers in an emergency, and other appropriate sources to verify information and obtain records as permitted by law. I agree to follow all current school policies, handbooks, tuition/payment agreements, attendance expectations, and student conduct requirements provided by the school.

Parent/Guardian Printed Name *

Parent/Guardian Signature (type full name) *

Date *

Student Signature (if age-appropriate)

Your information is kept confidential. The enrollment team will follow up within 2 business days.
Questions? Call (850) 824-1333

Enrollment Form K5–8