Required Items/Admissions Forms:
q Birth Certificate
q Social Security Card
q Photo I.D.
q Current Physical
q Insurance Card
q Medical Records
q School Records
q Shot Records
q Family Photo
q Assessment Summary
q Admissions Contract (notarized)
q Power of Attorney (notarized)
q Contact Form (with emergency numbers)
q A signed copy of Discipline Policies
q A signed copy of child abuse procedures
q Tuition Payment
Please check off the list and make sure that all items are included in the package you send to us by Fed-Ex service, including this signed page!
_________________________________
|
ABM
Ministries Assessment Summary |
||||||||
|
|
|
|
|
|
|
|
|
|
|
Date: |
|
|
|
|
|
|
|
|
|
Student
Name: |
|
|
|
|
|
|
|
|
|
Date of
Birth: |
|
Age: |
|
|
|
|||
|
Home
Phone: |
|
|
Work
Phone: |
|
|
|
||
|
Church
Affiliation: |
|
|
|
|
|
|
|
|
|
Pastor's
Name: |
|
|
|
Telephone
Number: |
|
|
||
|
|
|
|
|
|
|
|
|
|
|
Medical
History: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please
list any medications the student is currently taking. |
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Hobbies/Interests: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent/Legal
Guardian Name/s and Address/es: |
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Print Name |
|
Print Name |
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Address |
|
Address |
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
City, State |
|
City, State |
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Zip Code |
|
Zip Code |
||||||
|
If student
lives at a different address from above, list below. |
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
Address |
City/State |
|
Zip Code |
|
||||
|
|
|
|
|
|
|
|
|
|