GHS Admission Form

Student Name*

Student Surname

Student Nickname

Student Date of Birth*

Student SSN/SIN

Student Home Phone

How Did You Hear About Us?*

Please list

Grade Applying for:*

Applying for:

2023 - 20242024- 20252025- 2026

Student Address

Street Address*

City*

State*

Zip

Country

Local School District of Residence

Local School

District County

District State

Student Gender *

MaleFemale

Student Ethnicity

Student Citizenship

Birth Country

Primary Language Spoken at Home *

Upload a Photo

Upload a File

(must be a jpg, gif or png file)

Has the applicant previously attended another school?

YesNo

Most Recent / Previous School Attended*

Previous School Address

Street Address

City*

State*

Zip

Country

Phone Number

From Date

To Date

Grade Completed

Has the applicant previously attended any other school?

YesNo

Second Most Recent / Previous School Attended*

Previous School Address

Street Address

City*

State*

Zip

Country

Phone Number

From Date

To Date

Grade Completed

Has the student ever been subject to major disciplinary action (suspension or dismissal) in any school?*

YesNo

If yes, please explain.

Has this student applied for admission at Golden Hills School previously?*

YesNo

If yes please indicate the grade and year that was applied for.*

What are the applicant's strengths:

In what areas does the applicant need extra support:

Please list all sports in which the student has participated (in order or preference).*

Please list any extracurricular interests, abilities and/or achievements:*

Please indicate if the applicant has ever been evaluated for the following?

If yes, please explain and provide professional reports to the admissions office.

Upload file or submit paper copies to the admissions office.

Upload a File

Have there have been any situations in the applicant’s life that the school should know about in order to meet his/her learning or developmental needs (i.e.frequent moves, frequent changes of school, death in the family, divorce, etc.)?*

YesNo

If yes, please explain.

Parent One Home Address

Street Address*

City*

State*

Zip

Country

Home Phone

Parent Guardian One

Last Name*

First Name*

Middle Name

Suffix

Salutation*

Gender*

MaleFemale

Relationship to Applicant*

Custodial Rights?*

YesNo

Financial Responsibility?*

YesNo

Receive Correspondence?*

YesNo

Marital Status

Email 1*

Email 2

Work Phone

Cell Phone*

Occupation

Job Title

Employer*

Employer Address

Employer City

Employer State

Employer Zip

Religious Affiliation

Current Church/Congregation

Highest Level of Education

School Name

Degree

Parent Guardian Two

(leave blank if not applicable)

Last Name*

First Name*

Middle Name

Suffix

Salutation

Gender*

MaleFemale

Relationship to Applicant*

Custodial Rights?*

YesNo

Financial Responsibility?*

YesNo

Receive Correspondence?*

YesNo

Marital Status

Email 1*

Email 2

Work Phone

Cell Phone*

Occupation

Job Title

Employer

Employer Address

Employer City

Employer State

Employer Zip

Religious Affiliation

Current Church/Congregation

Highest Level of Education

School Name

Degree

Are there grandparents related to the applicant?

YesNo

Please complete if student(s) resides with Grandparent(s) only.

Grandparent Address One

Street Address

City

State

Zip

Country

Home Phone

Grandparent One

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Grandparent Two

(leave blank if not applicable)

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Is there another set of grandparents related to the applicant?

YesNo

Grandparent Address Two

Street Address

City

State

Zip

Country

Home Phone

Grandparent Three

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Grandparent Four

(leave blank if not applicable)

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Does the applicant have a parent/guardian that lives at another address?

YesNo

Please tell us about the applicant's additional custodial household.

Parent Three Home Address

Street Address

City

State

Zip

Country

Home Phone

Parent Guardian Three

Last Name

First Name

Middle Name

Suffix

Salutation

Gender

MaleFemale

Relationship to Applicant

Custodial Rights?

YesNo

Financial Responsibility?

YesNo

Receive Correspondence?

YesNo

Marital Status

Email 1

Email 2

Work Phone

Cell Phone

Occupation

Job Title

Employer

Employer Address

Employer City

Employer State

Employer Zip

Religious Affiliation

Current Church/Congregation

Highest Level of Education

School Name

Degree

Parent Guardian Four

(leave blank if not applicable)

Last Name

First Name

Middle Name

Suffix

Salutation

Gender

MaleFemale

Relationship to Applicant

Custodial Rights?

YesNo

Financial Responsibility?

YesNo

Receive Correspondence?

YesNo

Marital Status

Email 1

Email 2

Work Phone

Cell Phone

Occupation

Job Title

Employer

Employer Address

Employer City

Employer State

Employer Zip

Religious Affiliation

Current Church/Congregation

Highest Level of Education

School Name

Degree

Are there grandparents related to the applicant?

YesNo

Grandparent Address Three

Street Address

City

State

Zip

Country

Home Phone

Grandparent Three

Last Name*

First Name*

Salutation*

Gender*

MaleFemale

Relationship to Applicant*

Marital Status

E-mail

Cell Phone

Grandparent Four

(leave blank if not applicable)

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Is there another set of grandparents related to the applicant?

YesNo

Grandparent Address Four

Street Address

City

State

Zip

Country

Home Phone

Grandparent Five

Last Name*

First Name*

Salutation*

Gender*

MaleFemale

Relationship to Applicant*

Marital Status

E-mail

Cell Phone

Grandparent Six

(leave blank if not applicable)

Last Name

First Name

Salutation

Gender

MaleFemale

Relationship to Applicant

Marital Status

E-mail

Cell Phone

Sibling 1

Sibling Name

Age

Grade

Current School

Sibling 2

Sibling Name

Age

Grade

Current School

Sibling 3

Sibling Name

Age

Grade

Current School

Emergency Contacts

Household 1Household 2Grand Parent 1Grand Parent 2

Add Another Emergency Contact ?

YesNo

Name

Phone Number

Relation

Add Another Emergency Contact ?

YesNo

Name

Phone Number

Relation

Doctor

Doctor Name

Doctor Phone

Area CodePhone Number

Doctor Address

Hospital

New Hospital

Dentist

Dentist Name

Dentist Phone

Area CodePhone Number

Dentist Address

Insurance

Company

Policy

Group

Permission To Treat

YesNo

Blood Type

Conditions & Comments

Medical Condition 1

Medical Condition 2

Medical Condition 3

Medical Condition 4

Allergy 1

Allergy 2

Allergy 3

Allergy 4

Does the applicant take any prescribed medication?*

YesNo

If yes, please list prescribed medications.

Why are you thinking of coming to Golden Hills School.*

Please rank and put in order the following factors in your school selection process according to importance: (1=most important; 10=least important)

	Rating
Convenient location
Quality of teachers
Character education
Nonsectarian program
Private high school acceptance
Safe, secure campus
Small group instruction
Sports, arts, and extracurricular offerings
Quality of facilities
Standardized test scores

If my child is accepted, I understand that I will pay an enrollment fee to reserve my child’s classroom placement. The enrollment fee is due at the time of contract signing and is not refundable.

I certify that all information given in the application process is complete and accurate. I understand that failure to disclose information about the applicant’s medical, educational or emotional history may affect the school’s admissions decision and that the school reserves the right to reverse an admissions decision, even after acceptance and enrollment, if such information has been withheld from the school. The suitability of any applicant for enrollment is at the sole discretion of Golden Hills School.

Release of Records

I waive my right to access confidential information contained in my child's admission file.

Signature

Date

Application Fee*

USDApplication Fee

Instructions & Resources

Applicant Information

Previous Schools

Additional Student Information

Household One

Grandparent Household

Household Two

Grandparent Household

Siblings

Emergency Contacts and Authorized Pickup

Medical Information

Parent Questionnaire

Parent Agreement/ Electronic Signature