Boyd-Buchanan School

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Application

Please fill out the following information in order to begin the application process. Fields in red are required.

Applicant Information

Applicant Name

First

Middle

Last

Preferred

Address

City

State

Zip

Sex Male Female

Proposed Year of Entrance

Grade Entering

Birthdate

Place of Birth

With whom does the applicant live? Both Parents Mother Father Other

Father (or Guardian) Information

Name

Home Phone

Cell Phone

Home Address same as applicant

City

State

Zip

Employer

Work Phone

Work Address

City

State

Zip

Profession

Position

E-Mail

Marital Status Single Married Separated Divorced Widowed Remarried

Alumnus? Yes No

Religious Preference

Congregation

Member? Yes No

Mother (or Guardian) Information

Name

Home Phone

Cell Phone

Home Address same as applicant

City

State

Zip

Employer

Work Phone

Work Address

City

State

Zip

Profession

Position

E-Mail

Marital Status Single Married Separated Divorced Widowed Remarried

Alumnus? Yes No

Religious Preference

Congregation

Member? Yes No

Schools Attended

School Name

Dates Attended -

Grade

Address

City

State

Zip

School Name

Dates Attended -

Grade

Address

City

State

Zip

List any physical, mental, or emotional condition, current medications and learning problems of which the school should be aware:

Indicate special interest/hobbies/activities: Art Music Performing Arts Sports
Other

Brother(s)/Sister(s)

Name

Age

Grade

Applying to BBS? Yes No

School Currently Attending

Name

Age

Grade

Applying to BBS? Yes No

School Currently Attending

Name

Age

Grade

Applying to BBS? Yes No

School Currently Attending

Please list the name and relationships of all relatives who attend or attended Boyd-Buchanan School. Also list the name of friends or relatives currently employed at Boyd-Buchanan:

Has the student ever been expelled, suspended, or asked to withdraw? If so, please give an explanation:

Financial Commitment

Neither submitting nor receiving an application constitutes a commitment by Boyd-Buchanan School. It is understood that parents or guardians assume responsibility for payment of all fees and tuition for each year their child is enrolled. Fees are non-refundable. The enrollment process will not be complete until all admission requirements have been fulfilled and the enrollment form and fee have been submitted.

School Policy

Every student will be given a copy of the school’s rules and regulations. Parents and students should read the handbook containing these policies, rules, and regulations. Parents and students must agree to abide by the school’s policies.

Commitment Statement

As the parent(s) guardian(s) of the student named in this application, we (I) hereby certify that the information given herein is correct: and further, that we (I) agree to the financial commitment stated; and further, to abide by the policies of Boyd- Buchanan School as stated in the Student Handbook; and further, that we (I) understand that we (I) are (am) committed to pay the non-refundable fees and tuition for each school year or portion of school year if the student is withdrawn by us (me), and further, that this commitment will continue for each school year the student attends Boyd-Buchanan School.

Signature

In lieu of a signature, please check the checkboxes below and fill in the name of both parents/guardians to act as a signature:

Mother (Guardian) Signature

Father (Guardian) Signature