ONLINE APPLICATION FOR ADMISSION

Please Check One:
Pre-School Kindergarten Grade:
Pre-School only: Massapequa Location Amityville Location Either

Applicant

Name: Gender...MaleFemale
First, Middle, Last

Address (line 1):
Address (line 2):
City, State and zip code:
Telephone:
SS#:
Date of Birth:
Place of Birth:

Church / School Information

Church Denomination:
Name of Church:
Present School:
Address (line 1):
Address (line 2):
City, State and zip code:
Phone:
Teacher:
Current Grade Level:
Public School District in which you reside:
Schools attended in past 3 years:

Family Information

If parent's address and home phone are the same, you may leave one blank.

Father's Name: Address (line 1): Address (line 2): City, State and zip code: Home Phone: Occupation/Position: Company: Business Phone: Cellular Phone: Pager:	Mother's Name: Address (line 1): Address (line 2): City, State and zip code: Home Phone: Occupation/Position: Company: Business Phone: Cellular Phone: Pager:
Applicant lives with: Both parents Father Mother Other
Siblings
Name: Age: School:
Name: Age: School:
Name: Age: School:
Name: Age: School:

General Information How did you hear about Grace Day School? Do you have relatives who've attended Grace Day School? Why do you wish to send your child to Grace Day School? Are there any health or physical conditions of which the school should be aware? Your name: Your e-mail address: Preferred contact method: Home Phone Mother's Home Phone Father's Home Phone Mother's Business Phone Father's Business Phone Mother's Cellular Phone Father's Cellular Phone Mother's Pager Father's Pager E-mail We will contact you shortly.