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Leif Ericson Day School 1037 – 72 Street Brooklyn, NY 11228 (718) 748-9023
APPLICATION FOR ENROLLMENT
Date_____________________ Applying for gradeNursery full halfPre-K full half
Name:___________________________________________________ ______Boy_______Girl_______ (Last) (First) Address:______________________________________ __City__________________Zip___________
Telephone: ( )________________________________ _Social Security #___________ ________
Date of birth____________________________________ Place of birth________ ______________
Present grade/school________________________________________________________ ________
Present school address_______________________ ______City_______________Zip__________
Child’s church/address_________________________ _____________________________________
Child’s religion______________________________ ___ Date of baptism_________________ ___
Father’s name _________________________ ________ Social Security #____________________
Address (if different than above) __________________ _________________________________
City________________________ ______ Zip____________ Phone ( )________________ _____
Occupation ___________________________________ ___Bus. Phone ( )_________ _________
Mother’s name ________________________ __________ Social Security # ____________ _____
Address (if different than above) _________________________ __________________________
City ________________________ _____Zip _______________Phone ( )____________ _________
Occupation _____________________________________ ___Bus. Phone ( ) _________ _______
In what way would either of your occupations be a helpful and valuable means to benefit your
child’s school? ______________________________________________________________
Siblings names and ages
Emergency contact Phone (_ ) PLEASE UPDATE EMERGRNCY CONTACT INFORMATION AS NEED ARISES. Pertinent medical information:
Over …
How did you hear about our school?
What do you consider to be your child’s strengths and weaknesses in school?
_____________________________________________________________________________________ _
Are there any physical, social, emotional, intellectual characteristics/problems of which the school should be aware? ___________________________________________ ___________________________________________
By signing below, I certify that to the best of my knowledge, this information is accurate and complete.
In desiring enrollment I agree to cooperate in accordance with the policies stated in the Parent/Student Handbook and support all school programs.
NO TRANSCRIPT WILL BE RELEASED UNLESS ALL TUITION OBLIGATIONS ARE SATISFIED FOR THIS CURRENT SCHOOL YEAR.
Applications for enrollment are considered without regard for religion, race, sex, color, national or ethnic origin.
Date: ______________ _____ Parent/guardian signature: _______________ ________________
MEDIA PERMISSION: Please circle choice. See arrow.
I, , am the parent or legal guardian of
(name of child).
I give / do not give Leif Ericson Day School the perpetual, royalty-free right to use (please circle choice)my child’s photo(s) in any manner they wish, whether combined with other photos or text (children’s names will NOT be used) in school publications, press releases, and on the school website.
****************************************************************************************************** SCHOOL USE ONLY
Date received ___________________________ Tour date ____________________
Application Fee paid __________ __________
Interview/Testing date __________________ Accepted______ Rejected______
Records received: test scores_ ___ report card __ __immunization record __ ___birth certificate __ ___
Confirmation of acceptance _______ ______ or Waiting list letter ____ ________ Starting date __ _______________
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