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750 Cottonwood Avenue, Kamloops, BC V2B 3X2

Phone 376-6900 Fax 376-6904



STUDENT APPLICATION Gr 8-12
Student Information
LegaI Name:
_______________________________________________________________________________________________
Last First Middle
Name Used (if different): ___________________________________________________________________________
Address: ________________________________________________________________________________________
City: ____________________________ Postal Code: _________________ Telephone: ___________________
Sex: ______ Birthdate: ________________ Grade applied for: ________ For School Year: (ie 01/02)_______________
DD/MONTH/YY

Date of this application: ___________________ School Last Attended: _______________________________________
School Address: ________________________________________ School Phone Number _______________________

FamiIy Information
Parents/Guardians Names:________________________________________________________________________
Marital Status: Married ________ Widowed ________ Divorced ________ Separated ________ Single ___________
Father's Employment:______________________________________________________________________________
Job Employer and Phone #
Mother's Employment: _____________________________________________________________________________
Job Employer and Phone #
Email (for school newsletter) ________________________________________
Emergency Contacts: (This should be a local person, someone who is usually home)
1._______________________________________________________________________________________________
Name Phone

2._______________________________________________________________________________________________
Name Phone

Other children in family of school age if not applying:

Name: _________________________ Age: ____________ Name: _________________________ Age: ____________

Name: _________________________ Age: ____________ Name: _________________________ Age: ____________

Reason they are not applying: _______________________________________________________________________

s there one person who was actively instrumental in your decision to enroll at KCS? ____________________________
FOR OFFICE USE ONLY:
Date Rcd: __________Interview Date: ___________
Reg Fee Rcd: ___________ Chq #:__________
August Tuition Rc'd _________ Chq #:________
Student Accepted: ________Date ___________
Copies of: Birth Cert: ____Rpt Crd:_____Med nfo: _____
LegaI Residency Form: _______
Parent Participation Program: Chq# _____ Date: ____
KCSA Fee____Chq #_____ Student #___________
KAMLOOPS
CHRISTIAN
SCHOOL
Aboriginal Ancestry: Yes Status Non-Status Metis
Band Name: _________________ On Reserve Yes, No
Church Information
Church Attending: ___________________________________________ Pastor: _______________________________
Youth Pastor: __________________________
Address of Church: __________________________________________ Phone: _______________________________

Father: Christian? _____Yes ______ No Mother: Christian? _____Yes ______ No

Has applicant ever made a profession of faith in Christ? _____Yes ______ No
f yes, when? _______________________________________
(For students in Grade 8 and above, please include a written personal testimony detailing your reasons for ap-
plying to KCS and your current relationship with the Lord.)
MedicaI Information
Family Physician: _________________________________________________________________________________
Name Phone
s the applicant on any regular medication? ____ Yes ____ No. Explain: ____________________________________
_______________________________________________________________________________________________
Does the applicant have any physical limitations, serious or life threatening allergies, or medical conditions?__Yes __No
Explain: ________________________________________________________________________________________
_______________________________________________________________________________________________
Does the applicant have any contagious or infectious diseases that might affect their enrollment in our school?
____ Yes ____ No Explain: _________________________________________________________________________
_______________________________________________________________________________________________

GeneraI Information
Has the applicant ever been expelled, dismissed, suspended or refused admission to another school? ______________
Explain: __________________________________________________________________________________
Has the applicant ever had disciplinary difficulties? __________
Explain: __________________________________________________________________________________
Has the applicant ever been in trouble with the law (arrested, etc)? __________
Explain: __________________________________________________________________________________
Has the applicant ever used tobacco, alcohol or drugs of any kind? __________
Explain: __________________________________________________________________________________
Please indicate pupil's most recent letter grade in the following academic areas:
English _____, Math _____, Science _____, Social Studies _____, French _____ (where applicable)
Has the applicant ever been retained or repeated a grade in school? __________
Explain: __________________________________________________________________________________
Has the applicant received tutoring or Learning Assistance time? f so, what subjects and how many sessions per
week? __________________________________________________________________________________
Has the applicant received Speech, Occupational or Physiotherapy? f so, when and how often? _________________
__________________________________________________________________________________________
How did you hear about our school? _________________________________________________________________
Please indicate your reasons for selecting this school. ___________________________________________________
_______________________________________________________________________________________________

This appIication must be fiIIed out compIeteIy before it can be processed. An appIication fee of $75.00 must ac-
company this form and is not refundabIe. An interview with the parents and chiId wiII be required before finaI
acceptance.
Parent Observations
Please rate your child with respect to each of the characteristics listed below by checking one or
more items under each heading which most nearly represent your evaluation.
PHYSICAL CONDITION
_____ Rugged and vigorous
_____ Good health
_____ Fairly healthy
_____ Somewhat below par
_____ Partially incapacitated due to
physical disability
_____ Frequently incapacitated
_____ No observation

EMOTIONAL STABILITY
_____ Maintains balance and control
under difficult circumstances
_____ Well-balanced and controlled
_____ Usually well-balanced
_____ Somewhat overemotional
_____ Frequently worried, anxious,
nervous or tense
_____ Highly excitable
_____ Frequently depressed or
discouraged
_____ nclined to be apathetic
_____ No observation

SELF DISCIPLINE
_____ Shows excellent self
discipline
_____ Shows good self-discipline
_____ Shows normal self- discipline
_____ Shows poor self-discipline
_____ Avoids difficult tasks
_____ Overindulges in hobby or
recreation
_____ Overeats
_____ Does not control temper
_____ Risks emotional stability with
over self-discipline

EXPRESSION OF FEELING
_____ Speaks well of others
_____ Tactful
_____ Non-argumentative
_____ Tactless
_____ Argumentative
_____ Fault-finding
_____ No observation

SOCIAL ACCEPTABILITY
_____ Sought by others
_____ Liked by everyone
_____ Liked by most people
_____ Liked by some people
_____ Tolerated by others
_____ Avoided by others
_____ No observation

UNSELFISHNESS
_____ Rarely fails to put interest of
others first
_____ Consistently considerate of
others
_____ Usually thinks of others first
_____ Frequently seeks own interest
even though others may be hurt
_____ Thinks only of self
_____ No observation

FRIENDLINESS
_____ Warmly friendly with many
_____ Moderately friendly with many
_____ Quiet or shy
_____ Cliquish
_____ Easily offended
_____ Generally aloof
_____ Often sullen
_____ No observation

LEADERSHIP
_____ Display marked ability to lead
others
_____ Sometimes leads in important
affairs
_____ Sometimes leads in minor
affairs
_____ Seldom takes the lead
_____ Probably unable to lead
people
_____ No observation

TEAMWORK
_____ Very effective in teamwork
_____ Works well with others
_____ Usually cooperative
_____ Seldom cooperates with
others
_____ Seeks to dominate
_____ Frequently causes friction
_____ No observation

FOLLOWING ORDERS
_____ Excellent in following orders
_____ Follows orders satisfactorily
_____ Sometimes follows orders,
sometimes not
_____ Does things his own way
regardless of others
_____ No observation

WORKMANSHIP
_____ Extremely good workmanship
_____ Satisfactory workmanship
_____ Usually shows satisfactory
workmanship
_____ Some work well done and
some poorly done
_____ No observation

PERSONAL APPEARANCE
_____ Consistently well-groomed and
neat
_____ Neat
_____ Usually neat
_____ Careless
_____ Over-meticulous
_____ No observation

PERSEVERANCE
_____ Perseveres in spite of
difficulties
_____ Consistently completes tasks
_____ Usually carries on to finish
_____ Finished easy tasks, but is
easily discouraged by difficulties
_____ Starts but habitually does not
finish tasks
_____ No observation

PERSONAL DEVOTIONS
_____ Has regular habits of Bible
study and prayer
_____ Has devotions regularly
_____ Usually has personal
devotions
_____ Frequently misses personal
devotions
_____ Has no regular habit of Bible
reading or prayer
_____ No observation

CHRISTIAN EXPERIENCE
_____ Profound and contagious
_____ Genuine and growing
_____ Genuine but mild
_____ Relatively superficial
_____ No observation

LIFESTYLE-M/F ReIationships
_____ Healthy/age appropriate
_____ Usually healthy/age appropriate
_____ Sometimes unhealthy & not age
appropriate
_____ No observation

LIFESTYLE-DRUGS & ALCOHOL
_____ Abstains from alcohol & illegal
drug use
_____ Has been involved in alcohol &
illegal drug use
_____ s currently involved with alcohol
& illegal drugs
_____ No observation

LIFESTYLE-LANGUAGE
_____ Avoids using profane, offensive
language
_____ Occasionally uses profane,
offensive language
_____ Regularly uses profane, offensive
language
_____ No observation
Parent Agreement

_____ have read the handbook for parents and students and fully understand the commitment am making.

_____ have discussed all items in the handbook relating to students with my child(ren). (High school students see
signature line below)

_____ agree to attend a Parent Orientation Session during my child(ren)'s first month of school.

_____ am supportive of the school's philosophy, aims and objectives. understand the standards of dress, conduct and
policies set forth by Kamloops Christian School in the Student Handbook, and agree to support and uphold these
standards and policies.

_____ authorize this school to employ such discipline as it deems wise and appropriate for my child and to cooperate
when the school administration feels it is necessary to have a conference with both parents.

_____ agree to pay annual tuition fees by lump-sum payment, ten, eleven or twelve post-dated cheques deposited with
the school on or before the first day of school in September, or by Pre-Authorized Payment. f circumstances
prohibit my payments from being on time will make an appointment with the Accounting Department to work out
an acceptable means of payment beforehand.

_____ realize that all students are expected to work at or close to their ability level and that all students are expected to
follow the student rules of conduct. understand that Kamloops Christian School reserves the right to suspend or
expel any student who fails to comply with the established regulations and discipline, or whose financial obligation
remains unpaid after the due date.

_____ agree to uphold and support the high academic standards of Kamloops Christian School by providing a place at
home for my child(ren) to study and pledge to give my encouragement to the end that homework and
assignments will be completed.

_____ agree to attend the Parent-Teacher Conferences and will support my child by attending school functions and
meetings where possible.

_____ have completed the Student Registration Form and have forwarded it to the school. now wish to proceed with
registration by arranging for an interview with the principal.

_____I have attached a registration fee of $75.00 per student which I understand is non-refundabIe unIess the
student is not accepted, or I decide to withdraw the appIication within 7 days of the interview. also
understand that my first month's tuition is non-refundable and must be included with my application. t will be
deposited on August 1.

_____ have filled out the application for Society membership. One adult member of each family is required to join the
Kamloops Christian School Association if qualified.

_____I wiII bring a copy of my chiId(ren)'s report card(s), and their birth certificate(s) to the interview.

_____ understand that applicants for Grade 8 and up are required to have a character reference filled out and mailed
directly to the school office by a Pastor, Sunday School Teacher or Youth Worker and have made the necessary
arrangements.

_____ realize that registration in some or all grade levels may be limited due to student number and limited space and
am willing to place our child(ren)'s name(s) on a waiting list if necessary.


Signature of Mother __________________________________________
Date _________________________________
Signature of Father ___________________________________________

understand the portions of the Handbook that apply to me:

Signature of Student _________________________________________ (for students in Grade 8 and up)
KAMLOOPS CHRISTIAN SCHOOL
Character Reference Form
(To be fiIIed out by Pastor, Sunday SchooI Teacher, or Youth Worker)

_______________________________________ has applied for admission for Kamloops Christian School. Thank you
for providing a character reference. This will assist us in making a wise decision. All information will be kept confidential.
Please return the completed form directly to the school office (Kamloops Christian School, 750 Cottonwood Ave,
Kamloops, BC, V2B 3X2) .

Please rate the applicant with respect to each of the characteristics listed below by checking one or more items under
each heading which most nearly represent your evaluation. n the space to the right, give specific instances which
support or interpret your judgment. Do not check items concerning which you feel uncertain or have had no opportunity
to observe.
PHYSICAL CONDITION
_____Rugged and vigorous
_____Good health
_____Fairly healthy
_____Somewhat below par
_____Partially incapacitated due to physical disability
_____Frequently incapacitated
_____No observation

EMOTIONAL STABILITY
_____Maintains balance and control under difficult
circumstances
_____Well balanced and controlled
_____Usually well balanced
_____Somewhat over emotional
_____Frequently worried, anxious, nervous or tense
_____Highly excitable
_____Frequently depressed or discouraged
_____nclined to be apathetic
_____No observation

SELF DISCIPLINE
_____Shows excellent self discipline
_____Shows good self discipline
_____Shows normal self discipline
_____Shows poor self discipline
_____Avoids difficult tasks
_____Over indulges in hobby or recreation
_____Over eats
_____Does not control temper
_____Risks emotional stability with over self discipline

EXPRESSION OF FEELING
_____Speaks well of others
_____Tactful
_____Non argumentive
_____Tactless
_____Argumentive
_____Fault finding
_____No observation






SOCIAL ACCEPTABILITY
_____Sought by others
_____Liked by everyone
_____Liked by most people
_____Liked by some people
_____Tolerated by others
_____Avoided by others
_____No observation

UNSELFISHNESS
_____Rarely fails to put interest of others first
_____Consistently considerate of others
_____Usually thinks of others first
_____Frequently seeks own interest even though
others may be hurt
_____Thinks only of self
_____No observation



FRIENDLINESS
_____Warmly friendly with many
_____Moderately friendly with many
_____Quiet or shy
_____Cliquish
_____Easily offended
_____Generally aloof
_____Often sullen
_____No observation



LEADERSHIP
_____Display marked ability to lead others
_____Sometimes leads in important affairs
_____Sometimes leads in minor affairs
_____Seldom takes the lead
_____Probably unable to lead people
_____No observation





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TEAMWORK
_____Very effective in teamwork
_____Works well with others
_____Usually cooperative
_____Seldom cooperates with others
_____Seeks to dominate
_____Frequently causes friction
_____No observation

FOLLOWING ORDERS
_____Excellent in following orders
_____Follows orders satisfactorily
_____Sometimes follows orders, sometimes not
_____Does things his own way regardless of others
_____No observation

WORKMANSHIP
_____Extremely good workmanship
_____Satisfactory workmanship
_____Usually shows satisfactory workmanship
_____Some work well done and some poorly done
_____No observation

PERSONAL APPEARANCE
_____Consistently well groomed and neat
_____Neat
_____Usually neat
_____Careless
_____Over meticulous
_____No observation

PERSEVERANCE
_____Perseveres in spite of difficulties
_____Consistently completes tasks
_____Usually carries on to finish
_____Finishes easy tasks, but is easily discouraged by
difficulties
_____Starts but habitually does not finish tasks
_____No observation

PERSONAL DEVOTIONS
_____Has regular habits of Bible study and prayer
_____Has devotions regularly
_____Usually has personal devotions
_____Frequently misses personal devotions
_____Has no regular habit of Bible reading or prayer
_____No observation

CHRISTIAN EXPERIENCE
_____Profound and contagious
_____Genuine and growing
_____Genuine but mild
_____Relatively superficial
_____No observation



Please give any information you can concerning the
applicant's character, spiritual development or family
background which might bear upon the applicant's success
in KCS.
LIFESTYLE-M/F ReIationships
_____ Healthy/age appropriate
_____ Usually healthy/age appropriate
_____ Sometimes unhealthy & not age
appropriate
_____ No observation

LIFESTYLE-DRUGS & ALCOHOL
_____ Abstains from alcohol & illegal
drug use
_____ Has been involved in alcohol &
illegal drug use
_____ s currently involved with alcohol
& illegal drugs
_____ No observation

LIFESTYLE-LANGUAGE
_____ Avoids using profane, offensive
language
_____ Occasionally uses profane,
offensive language
_____ Regularly uses profane, offensive
language
_____ No observation


Comments:
_______________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________


Date:_____________________________________

Signature:_________________________________

Name: ___________________________________

Position: __________________________________







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