(back to home page)
Central Park Christian School
2011-2012
1900 - 43rd Street West
Birmingham, Alabama 35208
Phone: 205/786-4811 Fax No. 205/786-0140
Website: www.cpcsonline.org
Ministry of Central Park Baptist Church
Date: ________________
Student Application
Social Security Number: _____-______-______
Student’s Name:_________________________________________________________
First Middle Last Nickname
Home Address:___________________________________________________________
Street City State Zip
Age:_______ Date of Birth:__________ Sex: Male Female Telephone #___________
Application for Grade (Please Circle):
K5 1 2 3 4 5 6 7 8 9 10 11 12
Previous Schools Attended:
_______________________________________________________________ ________
Name Address Grade
_______________________________________________________________ ________
Name Address Grade
_______________________________________________________________ ________
Name Address Grade
Ever dismissed or suspended at any other school? Yes No
Family Record:
Father_______________________ Living? ________________________
HomeAddress____________________________________________________________
Business Address_________________________________ Bus. Phone_____________
Mother_____________________ Living? ________________________
Home Address___________________________________________________________
Business Address_________________________________ Bus. Phone______________
Children in Family (Names and Ages)
______________________________________________________________________
Are any of your children now enrolled in Central Park Christian School?
If so, please give names and grades.
_______________________________________________________________________
Church Affiliation_________________________________________________________
Applicant’s Church Membership________________________________________________
Family Physician: (Local)_____________________________________________________
Telephone # _____________________________________________________________
Physical Disability: If any, explain______________________________________________
In case of emergency and parents cannot be reached, call______________________________
Name of person(s) authorized to transport this child
________________________________________________________________________
Give a brief statement of the reason for this application:
________________________________________________________________________
________________________________________________________________________
Parental Agreement
All applications are made with the understanding that pupils are entered for the entire
school year. Applicants agree to abide by rules and regulations of Central Park Christian
School. Parents agree for instructions of their children in the Christian Faith and to this
philosophy of education in all phases of the curriculum.
The signature of the parents or guardians on this application form constitutes acceptance
of the above conditions and stipulations and is an agreement to make ________ per year.
______________________________ ______________________________
Father’s Signature or Legal Guardian Mother’s Signature or Legal Guardian
Date: __________________________
Admitting students of any race, color, national, or ethnic origin.
“And Jesus increased in wisdom and stature, and in favor with God and man.”
Luke 2:53
(back to home
page)