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Enrollment Application

We are honored that you have chosen Lumberton Christian Learning Center for your child’s education needs. Please fill out the form below to get the process started!

Childs Name *

First

Last

Primary Parent Contact Name *

First

Last

Please list the parent who will be the "primary" contact for the child.

Primary Parent Contact Email Address *

This is the email address we will use to reply to this application.

Child's Address *

Child's Phone

If child has his/her own phone. If not, please list parent's numbers below.

Child's Date of Birth *

Enrolling Child *

Male
Female

Child's Age *

Student's Social Security Number *

Mother's Name *

Mothers Email

Mother Employed By

Mother's Business Phone

Mother's Cell Phone *

Father's Name *

Fathers Email

Father Employed By

Father's Business Phone

Father's Cell Phone *

Parents Marital Status

Married
Widow
Divorced
Separated

Initial Enrollment Grade At Lumberton Christian Learning Center *

Kindergartens
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade

School Last Attended *

School Last Attended Year *

School Last Attended Grade Completed *

School Last Attended - Complete Address *

Academic Level At Previous School *

Excellent
Good
Average
Fair

Has Child Ever Been Retained? *

Yes
No

If so, what year?

Has Child Ever Been Suspended/Expelled? *

Yes
No

If yes, give year and reason.

Has Child Ever Been Refused Admission To Another School? *

Yes
No

If so, please explain.

Has Child Ever Experienced Any Disciplinary Difficulties? *

Yes
No

If yes, please explain here.

Does The Student Have An Individualized Education Plan (IEP) Provided Under The Federal Individuals With Disabilities Act (IDEA of 1997)? *

Yes
No

Has The Child Ever Been Arrested? *

Yes
No

Has The Child Ever Been Prosecuted For A Crime? *

Yes
No

Has The Child Ever Used Tobacco, Alcohol, Or Illegal Drugs? *

Yes
No

Family Physicians Name/Provider *

Family Physicians Address *

Family Physicians Phone Number *

Please List Any Physical Disabilities or Allergies

Has The Child Received All The Required Immunizations? *

Yes
No

If not, please list.

I understand that Lumberton Christian Learning Center has the right to determine the grade to which the child shall be assigned. Suspend or expel the child for any scholastic or disciplinary reason or cause. Judge the sufficiency of such reason or cause. Accept or not accept this applicant as a student. *

I agree
I do not agree

Lumberton Christian Learning Center maintains high personal and academic standards because of the belief that Christians should display excellence in every area of life. We recognize that these standards run contrary to current, popular lifestyles. However, our purpose is to reflect a quality of living that is exemplary of Biblical Standards. The schools sees itself as being a support role to parent. We hold that parents are primarily responsible for their child's development. Therefore, we rely heavily on active parental participation in their child's school life. Since it is our belief that excellence should be maintained and that parents should be involved, we need your cooperation in the following major areas. Matters of discipline, school attendance/tardies, and homework assignments. We also require parent's responsibilities on meeting tuition and payments in a timely fashion. *

I agree
I do not agree

It is understood and agreed that tuition is due on the 12st of EACH MONTH. A late fee of $5.00 will be charged starting on the 2nd of each month and continuing each day until fees are paid. It is further agreed that if tuition is not paid by the 15th of the month the student may be suspended until full payment is made. It is through a joint effort with parents and staff that Lumberton Christian Learning Center will be a maximum service to your child. Your signing of this form indicates your willingness to become involved and supportive. *

I agree
I do not agree

I have answered the questions on all forms contained herein truthfully and to the best of my ability. I have never been, nor am I currently involved in litigation against a private/Christian School or the employees thereof. I understand that attendance at Lumberton Christian Learning Center is a privilege and not a right, which privilege may be forfeited by any student who does not conform to the standards and regulations of Lumberton Christian Learning Center and that Lumberton Christian Learning Center may request withdrawal of any student at any time. *

I agree
I do not agree

Mother *

First

Last

Father *

First

Last

By Entering Your Name Above You Agree To ALL The Terms Of This Application. *

YES
NO

*Submission of this application does not guarantee your child’s admission.

Where Education Meets God's Purpose!

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Meet Giuseppe

The School Mascot

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