River Canyon School RIVER CANYON SCHOOL APPLICATION FOR ENROLLMENT. To be completed by parent or guardian.

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1 River Canyon School Early Childhood Programs inspired by Waldorf Education River Canyon School Rd Grand Junction, CO Contact us at or RIVER CANYON SCHOOL APPLICATION FOR ENROLLMENT To be completed by parent or guardian. A non-refundable application fee of $50 is required of each applicant Applicant information Class Applying for for the year beginning fall Today s Date Name of applicant First Middle Last Nickname if any Address City State Zip Date of Birth Male Female Home phone R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 1

2 Please circle a program below: MIXED AGE KINDER PROGRAMS Circle your choice Full Day Kindergarten (8:30-3:30) Half Day Kindergarten (8:30-12:30) Half Day Kindergarten 2 days (8:30-12:30) Extended (12:30-3:30) 4 days $590 EVERYDAY Until 3:30 4 days $385 EVERYDAY! Until 12:30 2 days $230 M / T / W / TH M / T / W / TH 2 days $135 3 days $205 There is a supply fee of $95 assessed in August and again in January for ALL students Family Information Father Home address Zip code Step-Father Address Mother Home address Zip code Step-Mother Address R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 2

3 In case of emergency, if neither parent can be reached, please contact: at this phone # Let us know who to contact first in an emergency situation (ex: mom first, then dad, third grandmother) 1 st Contact: 2 nd Contact: 3 rd Contact: Person(s) designated to pick up and deliver child (other than parents/guardians): Name: Phone: Relationship: Name: Phone: Relationship: Name: Phone: Relationship: Marital Status of Parents: Together Separated Divorced Custody Visitation Rights Father remarried Father deceased Mother remarried Mother deceased Student(s) lives with Relationship Tuition to be paid by whom? Person not permitted to call for child (provide court documents) Child s doctor name: Phone: Address: Child s dentist name: Phone: Address: Child s Hospital of Choice: SMH: 2635 North 7th Street, Grand Junction, Colorado ph: Community Hospital : 2021 N 12st Grand Junction, CO ph: Other: ph: R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 3

4 Siblings information Name Gender: M/F Age: Grade: School: Name Gender: M/F Age: Grade: School: Are you applying to River Canyon School for any of the above siblings? If yes, which child(ren)? Previous Schools Please list the applicant s previous schools starting with the current school Current school Years attended Grades Current school Years attended Grades Other adults living with child (list relation to child) Name: Relationship: Name: Relationship: Name: Relationship: Please explain why you are interested in River Canyon School. Include materials you have read, lectures attended, and how you heard of the school. Are you acquainted with anyone in the school? R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 4

5 Please describe any circumstances that have affected or may have affected your child s school experience (include your child s previous experience in child care). Please describe your child s interests, musical instruments played, special talents, or hobbies. Has your child received, or is he o she now receiving special tutoring, counseling or therapy? If yes, explain. Include nature and dates of service- (attach a detail explanation if necessary). Please identify any health situations the school should know about, such as diagnosis, allergies, therapy (physical or psychological), medications. Has your child ever studied a foreign language? If so, please specify. R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 5

6 What role does media (TV, videos, movie, computer games, etc) play in your family? Provide any information concerning your child which might be helpful to teachers in regards to: -Sleeping habits (wakes by self, needs awakening, mood upon awakening?) -Dressing (by self, who chooses clothes, etc), breakfast (light/substantial, eaten together/alone) -Dinner (usual time, who is present) -After dinner activities -Bedtime habits/rituals River Canyon School is a community school and parents are expected to join us in the adventure of education. In what ways would you be interested in participating? At the time of admission, the undersigned parent or guardian understands that RCS services will be billed at the rate designated in the signed contract between parent/guardian and River Canyon School. Parent signature Parent Signature Date: Date: R C S A p p l i c a t i o n f o r E n r o l l m e n t Page 6

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