Redeemer Lutheran School

APPLICATION FOR ADMISSION

THE $30.00 NON-REFUNDABLE APPLICATION FEE MUST ACCOMPANY YOUR APPLICATION

Student’s Name _________________________________________________________________________________

Last First Middle
Home Address___________________________________________________________________________________
Street City State Zip

Enrolling in Grade: __________ Telephone ( ) ________________ Sex: Male _____ Female______

Date of Birth ______________________ Place of Birth _____________________________________________

City State/Country

Race ____________________ Country of Citizenship _____________________

FATHER MOTHER

Name _______________________________________ Name _______________________________________

Home Address ____________________________ Home Address ____________________________

_____________________________________________ _____________________________________________
City State Zip City State Zip

Home Phone _______________________________ Home Phone _______________________________

Cell Phone _________________________________ Cell Phone _________________________________

Occupation ________________________________ Occupation ________________________________

Employer ___________________________________ Employer ___________________________________

Job Description/Title ______________________ Job Description/Title ______________________

Business Phone ___________________________ Business Phone ___________________________

E-Mail Address _____________________________ E-Mail Address _____________________________

Name of Step-Father ______________________ Name of Step-Mother ___________________

Applicant’s natural parents are:

Married Divorced Separated Father Deceased Mother Deceased

The child lives with _____________________________________________________________________________

Siblings ________________________________________ Age __________ Grade _________________________

Siblings ________________________________________ Age __________ Grade _________________________

Siblings ________________________________________ Age __________ Grade _________________________

Special or unusual family circumstances we should be aware of ____________________________

___________________________________________________________________________________________________

Church Affiliation _______________________________________________________________________________

Congregation Denomination Pastor

Child is baptized _____________________________ Date of Baptism ______________________________

How did you hear about Redeemer? ___________________________________________________________

School most recently attended ______________________________________ Grade completed ______

School address _________________________________________________________________________________

Street City State Zip

TUITION AGREEMENT

Person responsible of tuition fees:

Name ____________________________________________________ Relationship to student ____________

Billing address __________________________________________________________________________________

Street City State Zip

I, hereby make formal application for my son/daughter _____________________________ to attend Redeemer

Lutheran School for the school year 20 ___________ - 20 ___________. I certify that the information given
herein for the purpose of obtaining admission to Redeemer Lutheran School is correct, and true to the
best of my knowledge. I agree to legally bind myself to pay all tuition and assessments in full in
accordance with the terms elected at the time of enrollment. I understand that all tuition and fees
must be paid in full before transcripts, report cards, diplomas, or transfers may be issued. I also
understand that should my child transfer, or expulsion become necessary during the school year that
all fees other than tuition are non refundable and that tuition will be refunded on a pro-rated basis.
I also agree to support the faculty and administration in their efforts to provide the best academic
and spiritual education for my child(ren).

I am enclosing the $30.00 non refundable application fee for my child.

Parent or Guardian Signature ___________________________________________________ Date ____________________