Phone Birthdate Male Female Soc.Sec.#

For emergency, please contact:

Relative Name Relative Phone

Friend Name Friend 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 10 months through FACTS Tuition Management Company. A 5% discount is applied if paid in full before the first attendance day. Multiple-child discounts are available.

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 toward tuition.

home|mission|calendar|upcoming|pce|register|resources