Hilltop Christian School
P.O. Box 9090 Window Rock, AZ 86515  (505) 371-5726

STUDENT INFORMATION:

Name:_____________________________________________________ Age: _____ Sex: _____

Mailing Address: __________________________________________ C.I.B._______________
                                     PO Box                                                  City                             State
Home Telephone #: (_____)_________________ Are you living with the child: _________

Parents or Legal Guardian's Name: _______________________________________________

Names & ages of other siblings: __________________________________________________

Has the child been to HCS before? ______ If yes, when? _____________________________

Has the child ever repeated a grade level? ______ If yes, what grade? __________________

Has the child ever been in serious disciplinary difficulties? _____
Has the child ever been suspended from a school? _____
Has the child ever been expelled from school before? _____
If yes, to any of the above, please explain: __________________________________________
________________________________________________________________________________

PARENTS OR LEGAL GUARDIANS

Father's Name: ___________________________________ Employer: _____________________

Mother's Name: __________________________________ Employer: _____________________

Parent's Marital Status: ___________________

Do the parents understand the plan of salvation as outlined in John 3:16 of the Bible?
Father:  Yes ______ No ______          Mother:  Yes ______ No ______

Are the parents born again Christians?
Father:  Yes ______ No ______          Mother:  Yes ______ No ______

Church or denominational attendance: _____________________________________________
Father: Church now attending _____________________________________ regularly? ______
Mother: Church now attending ____________________________________ regularly? ______

Personal references: (Please list two people not a relative.)

1) Name: __________________________________________________ Phone #: _____________

2) Name: __________________________________________________ Phone #: _____________

How did you learn of Hilltop Christian School?
Family Member ______ Friend ______ HCS Alumni ______ Radio ______

State in detail why you choose Hilltop Christian School for your child's education:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Would you like to volunteer in certain areas? _______________________________________

In what areas would you like to volunteer? _________________________________________

We or I have read the HCS handbook and understand the policy and procedures and agree
to abide by and fully support the rules and guidelines set forth.  Yes ______  No ______

Comments: ______________________________________________________________________

Father's signature: ______________________________________________ Date: ____________

Mother's signature: _____________________________________________ Date: ____________

Legal Guardian: ________________________________________________ Date: ____________

Admission Approval

Name of Account Holder: __________________________________ SS#:___________________

Checklist:
_____ Complete Student Application (Address, Phone#'s, Signatures, etc.)
_____ Physical Address Form
_____ Student Health History
_____ Permission to use photography form
_____ Emergency Information (Must have 3 names with address & phone #'s - 2 copies
           for pre-school)
_____ PHS/HIS - DHHS form
_____ Navajo Area Dental Program form (2nd and 7th grades only)
_____ Internet policy (does not apply to pre-school)
_____ Immunization Record (Must be up to date, the school nurse will contact you)
_____ Birth Certificate (new students and pre-school)
_____ Bus Application (optional)
_____ Court Documents (Required if the child is placed with legal guardian)
_____ Transfer of cumulative records (Must have it on file before acceptance)
_____ Annual fee $1675.00 (includes registration, books and tuition) or
_____ 9 month payment schedule (Aug-Apr) $186.11 a month or
_____ 10 month payment schedule (Aug-May) 167.50 a month
_____ Unattended Child Policy
_____ Questionnaire for Library

Your child will not be accepted if any of the above checklist is not checked off. Please
consider updating your child's immunization before attending the first day of school.
Due to New Mexico State law, no child will be accepted into the classroom without an updated immunization.