Will student be four (4) years old before September 1? *

If No, student is NOT eligible for enrollment

Yes

No

Is student able to use the restroom independently? *

Yes

Will be by first day of school, August 25

Student Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Date of Birth *

MM

DD

YYYY

Parent 1 Name *

First Name

Last Name

Parent 1 Phone Number *

(###)

###

####

Parent 2 Name

First Name

Last Name

Parent 2 Phone Number

(###)

###

####

Father's Work Number

(###)

###

####

Address

Father's Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Work Number

(###)

###

####

Address

Mother's Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pastor's Name

First Name

Last Name

How Did You Hear About GCS? *

Please check any/all that apply

Referral from Family or Friends

Print Advertising

Radio Advertising

Billboard

Social Media

Website

Lawn Sign

Direct Mail - Welcome Wagon

Other