Phone Birthdate Male Female

For emergency, please contact:

Relative Name Phone

Friend Name Phone

I authorize my child to be released to:

or or

I give permission for my child to go on school-sponsored field trips during the 2003-2004 2004-2005 school year. I understand that my child will travel in a private vehicle driven by a teacher or parent. If I do not want my child to participate in the trip, I will notify the school the day prior to the planned trip.

Parent/Guardian Signature__________________________________________________________________Date____________________________

I give permission for my child to receive emergency medical treatment if necessary from a teacher or administrator of WCS during the 2003-2004 2004-2005 school year. This treatment will be administered only in the event that I cannot be located within a reasonable amount of time following an accident that demands treatment.

Parent/Guardian Signature__________________________________________________________________Date____________________________

My child is physically and mentally able to participate in group activities. My child is participating in an ongoing health supervision program with annual evaluations and scheduled immunization.

Parent/Guardian Signature__________________________________________________________________Date____________________________

Please note any physical problems:

Physician's Name Address Phone

Please attach a copy of your child's immunization record and the registration fee with this form and mail to:

Wichita Christian School
4729 Neta Lane
Wichita Falls, TX 76302

Tuition is payable over 9 months September through May. Tuition is due by the 10th of each month. A 10% discount is applied if paid annually or a 5% discount if paid by the semester. A family discount on tuition and registration fees applies with families with two or more children in M/W school.

Please note: Your child's place in class will be secured upon WCS receiving this form and payment of registration fees. Registration fees will not be refunded or applied to tuition.

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