The Shenandoah School Application for Admission 2006 – 2007 school year Student Information: __________________________________________________________________ Child’s Name: (Last) (First) (Middle) Name you wish your child to be called: ___________________________ Age: ________ Date of Birth: ___________________ Gender: M / F Mailing Address: _________________________________________________________________ City _____________________________ State _______ Zip code _______ Is this your child’s first time in a school setting? _____ Name of preschool previously attended (if applicable) _________________________________________________ Dates of attendance: __________________ Family Information: ___________________________ ______________________________ Mother’s Name Father’s Name ___________________________ ______________________________ ___________________________ ______________________________ Address (if different) Address (if different) ___________________________ ______________________________ Home Phone Home Phone ___________________________ ______________________________ Occupation Occupation __________________________ ______________________________ Employer Employer ___________________________ ______________________________ Work / Cell Phone Work / Cell Phone ___________________________ ______________________________ E-mail Address E-mail Address Parents are (check all that apply): __Married __Separated __Divorced __Single Parent __ Mother is remarried __ Father is remarried Sibling’s Names and Ages: _____________________________________________________________ _____________________________________________________________ Please continue on next page The Shenandoah School ~ 1115 Gardners Lane ~ Shepherdstown, WV 25443 ~ 304- 876- 3551 ___________________________________________________________________________________ The Shenandoah School Application for Admission 2006 – 2007 school year Page 2 School Operation: The school hours are 9:30 am to 1:30 pm Class Preferred: ___ 5 day program Monday thru Friday ___ 3 day program Monday, Tuesday, Wednesday ___ 2 day program Thursday, Friday Describe the learning environment you are seeking for your child: ___________________________________________________________________ ___________________________________________________________________ Is there any physical, medical, emotional or educational concern that we should be aware of? If so please explain: ___________________________________________________________________ ___________________________________________________________________ Guidelines for admittance: ~ Children must be at least three years old by October 1st 2006. ~ All children attending The Shenandoah School must be fully potty trained. ~ The Shenandoah School is located in a rural area of Shepherdstown. Out of respect for the neighbors, we ask that you drive safely and slowly on the country roads surrounding the school. We do not wish to aggravate the neighbors with speeding cars on Gardners Lane. ~ The Shenandoah School welcomes diversity and admits students without regard to race, color, creed, sex, national, or ethnic origin. The staff may not discriminate in the administration of the school’s policies and programs. ~ Since we offer a stimulating and challenging academic program, the most important consideration in evaluating the admission of a child, is that he /she have a reasonable chance of academic and personal success in our environment. ~There is a $50 application fee, which is non-refundable if your child is admitted to The Shenandoah School. Checks should be made payable to The Shenandoah School, and sent with the completed application to: The Shenandoah School P.O. Box 1132 Shepherdstown, WV 25443 How did you hear about The Shenandoah School? _____________________ ______________________________________________________________________ The Shenandoah School ~ 1115 Gardners Lane ~ Shepherdstown, WV 25443 ~ 304- 876- 3551