Student's Name (required) Student's Grade (required) Date of Birth (required) Parent's Name (required) Daytime Contact Number (required) Today's Date (required) Your Email (required) (For 1st-11th) What school is the child currently enrolled in? List of previous schools (include name, address, dates attended) Briefly state your reasons for desiring your child’s enrollment in Community Christian School: Has your child ever received diagnostic testing for learning disability (including ADD/ADHD)?: If yes, please explain – including diagnosis and treatment Does your child require any special curricular or classroom modifications? If yes, please explain: (For 1st-11th) Has student failed any grades/subjects or was retained? (For 1st-11th) Has student failed any grades/subjects or was retained? If yes, please explain (For 1st-11th) Has student been refused admittance, placed on academic or disciplinary probation, suspended or expelled from any school(s)? If yes, please explain: Has student ever been placed in a grade instead of being promoted? What grade? What church does your family attend? Name & grade of sibling(s) not seeking enrollment at CCS: Any other information that the school needs to know: Would you like to be scheduled for a school tour? What is the best time to call?