Child's Name: __________________________________

Date of Birth: _____________________

Age:

________

Male:

________

Female:

________

What grade will your child be entering next year? _______________

Child's School History
(For children entering kindergarten, please include preschool or nursery school experience):

School's Name: ____________________________________________

Address: ________________________________________________

Phone: _________________________________________________

Date Attended: _____________________________

Teacher: __________________

Grade Level: __________________

 

School's Name: ____________________________________________

Address: __________________________________________________

Phone: _________________________________________________

Date Attended: ____________________________

Teacher: __________________

Grade Level: __________________

 

School's Name: ____________________________________________

Address: __________________________________________________

Phone: __________________________________________________

Date Attended: _____________________________

Teacher: __________________

Grade Level: __________________

 

I give permission for my child's current teacher to be contacted.

Yes ____ No ____

 

I give permission for a Center School staff member to visit my child's school.

Yes ____ No ____

 

Please describe briefly any special services (such as tutoring, speech therapy, counseling, etc.) that your child receives.

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

 

What is the ethnic background of your child?

______________________________________

 

Why are you interested in having your child attend Center School?

______________________________________________________________

______________________________________________________________

______________________________________________________________

 

Will you be applying for a financial aid? Yes____ No____

 

What other schools are you applying to?

 

Parent or Guardian Name: ______________________________

Address: ____________________________________________

Home Phone: ________________________________________

Employer: ___________________________________________

Occupation: _________________________________________

Business Phone: _____________________________________

Email Address: ________________________________________

 

Parent or Guardian Name: ______________________________

Address: ____________________________________________

Home Phone: ________________________________________

Employer: ___________________________________________

Occupation: _________________________________________

Business Phone: _____________________________________

Email Address: ________________________________________

 

Names and birth dates of siblings:

_______________________________________________________

_______________________________________________________

If parents are separated or divorced, who has primary legal custody of the child?

_______________________________________

 

With whom does the child live? _____________________________________

 

Parents' Signature: _____________________________________

Date: ____________________

Please enclose a $40 application fee and mail to:
Greenfield Center School
71 Montague City Road, Greenfield, MA 01301
413.773.1700 (voice)
413.774.1135 (fax)
Contact: The Admissions Office for more information.

GCS is a nonprofit, 501 (c) (3), educational organization governed by a Board of Directors. GCS does not discriminate on the basis of race, color, religious creed, gender, sexual orientation, handicap, age, ancestry, or national or ethnic origin.