Student Legal Name*

First Middle Last

Student SSN*

Student's Address*

Street Address City State ZIP Code

Grade Entering*

Age (as of August 1st)*

Sex*

Male

Female

Date of Birth*

Place of Birth*

Education Background*

Returning DCS Student

New Student

Transfer Student from Another School

Transfer Student from Home School

Previous School Name*

Previous School Address*

Street Address City State ZIP Code

Previous School Phone*

Previous School Status*

Passed

Passed Conditionally

Retained

Do you have a pediatrician or family doctor?*

No

Yes

Doctor's Name*

First Last

Doctor's Phone*

ER Hospital Preference*

Do you have health insurance?*

No

Yes

Insurance Company*

Policy Number*

Insurance Phone*

Emergency Contact Information

We require a minimum of one emergency contact.

Emergency Contacts*

Name

Phone

Relation to Student

Over the Counter Medication

I give permission for Dayspring School Administration to administer over the counter medication such as Tylenol, Ibuprofen, Benadryl or throat lozenge.

I do not give permission for Dayspring School Administration to administer over the counter medication such as Tylenol, Ibuprofen, Benadryl or throat lozenge.

By signing below and submitting this form, I understand that my digital signature is legally binding.

Digital Signature*

Date*

Throughout the school year, students may be highlighted in efforts to promote Dayspring Christian School (DCS) activities and achievements. For example, students may be featured in materials to train teachers and/or increase public awareness of our school through newspapers, radio, TV, newsletters, the web, DVDs, displays, brochures, yearbooks and other types of media.

Please select your preference for media permission for your child.

By signing below and submitting this form, I understand that my digital signature is legally binding.

Digital Signature*

Date*

Middle School Electronic Device/Phone Policy

Those in 6th through 8th grade are not allowed to have cellphones/electronic devices out at any time before or during school (7:30am-2:50pm). Cell phones are only allowed to be used after school hours.

Discipline Procedure:

First Offense - phone confiscated and given a warning
Second Offense - phone confiscated, 1 day of ISS; phone call to parent
Third Offense - phone confiscated, 3 days of ISS; phone call to parent, request made that they no longer bring their phone to school

High School Electronic Device/Phone Policy

Those in 9th through 12th grade are allowed to use their phones/electronic devices before school, on breaks between classes, and during lunch. They are NOT allowed to be used or seen at any time during class periods, unless permission is given by their teacher.

Discipline Procedure:

First Offense - phone confiscated and given a warning
Second Offense - phone confiscated, 1 day of ISS; phone call to parent
Third Offense - phone confiscated, 3 days of ISS; phone call to parent, request made that they no longer bring their phone to school

Digital Student Signature*

Date*

Digital Parent/Guardian Signature*

Date*

We consider attendance at Dayspring Christian School a privilege, therefore, Christ-like behavior is the primary responsibility of each student. A student may be asked to leave our school if attitude, behavior, academic effort or self-discipline falls short of our standard.

Code of Conduct:

Honor to God
Honor to Self
Honor to Authority
Honor to Peers
Honor to Property

The above areas are relevant to the general guidelines for enrollment at DCS and can be found on pages 11-15 of the handbook.

Digital Student Signature*

Date*

Digital Parent/Legal Guardian Signature*

Date*

State law requires proof of citizenship and immunization records. In this case we require a copy of a birth certificate and immunization records for each student.

If you have a medical release form for immunizations you will need to fax that info from your doctor.

We do have Religious Exemptions Forms available in the school office at your request.

For your convenience, you may upload a copy of your child's birth certificate and immunization records. You may also bring these to our office at a later date if you are unable to upload them now.

Birth Certificate

Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.

Immunization Records

Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.

Parent/Guardian Digital Signature*

Date*

Name

This field is for validation purposes and should be left unchanged.

Apply Online

Application Form

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

Middle School Electronic Device/Phone Policy

High School Electronic Device/Phone Policy

Helping Students Achieve Their God Given Destiny