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(315) 568-2216 scott.vankirk@fingerlakeschristianschool.com

Enroll Your Child

A PDF version of the Student Application is available here.

Enrollment Application

The Application Process

Within two weekdays after you submit your child's application you'll be contacted by the Principal to set up an enrollment interview.

At the enrollment interview

1. The Principal will make certain that the enrollment criteria are met;

2. Your child will be tested in math, phonics, reading comprehension and writing to determine the correct grade placement. Students entering 10th grade or above are not tested - transcripts from the previous school determine grade placement;

3. Your child, if in 7th grade or above, will be asked to sign the Student Agreement. 7th-12th grade students re-sign this agreement at the beginning of every school year.

4. You will be asked to sign paperwork affirming that you have thoroughly read, understand and are in agreement with the documents listed below.

Please thoroughly read and understand the following documents before beginning the enrollment application.

The following documents require your electronic signature in order for an enrollment interview to be scheduled. You will be asked to sign hard copies at the interview.

Date:*
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Applicant's Name:*
Grade Entering*
Entrance Date*
DOB*
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School District*
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Parent/Guardian #1*
Emergency Contact?*
Authorized to pick up?*
Address*
Primary Phone*
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Secondary Phone
-
Emergency Phone
-
E-mail*
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Parent/Guardian #2
Emergency Contact?
Authorized to pick up?
Address:
Primary Phone:
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Secondary Phone:
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Emergency Phone:
-
E-mail:
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List all previous schools attended by this child beginning with the most recent. Include homeschooling years.*
Has your child ever repeated a grade?*
If Yes, which grade?
If your child is experiencing difficulties at his/her current school, please explain.*
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Why do you want your child to attend FLCS?*

If your child is transferring from another school, we will request his or her educational and health records directly from the school. If your child has been home schooled in any of the last three academic years, please  include academic transcripts with this application.

Transcripts may be mailed, emailed, faxed, or uploaded to FLCS:

Finger Lakes Christian School
2291 Rt. 89
Seneca Falls, NY 13148

office@fingerlakeschristianschool.com

Fax: 315-568-6638
Upload a File:
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Parent/guardian testimony of Christian faith

As you’ve already read, a requirement for enrollment is that at least one parent or guardian living in the home with the student must be a born-again Christian. Are you born again? If that term is unfamiliar to you, please click here.

If you are born again, please write a short paragraph describing your salvation experience.

Father/guardian*
Mother/guardian*
What is your church affiliation?*
How often do you attend?*
Pastor's Name:*
Pastor’s Phone*
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Medical information

Medical Information

If your child becomes ill or has an accident in school, first aid will be given and you will be notified. The responsibility for further treatment rests with you and your family physician. It is extremely important that your emergency notification information is kept up to date (see page 8). Please report any changes to the school office as soon as possible.

Most injuries/accidents are brought to the attention of the child's teacher but, occasionally, a child does not report an injury. If your child has sustained a school-related injury that you believe was not reported, please notify the office so that the appropriate documentation can be made.

If your child is ill, please do not send him to school. Many symptoms require a judgment call on your part, but these two do not: running a fever or vomiting. In either case the student must stay home from school. A child exhibiting these symptoms in school will be immediately separated from the student body and you will be asked to pick him up. Please remember that we do not have a full-time nurse on staff, so it is necessary that you consult your family physician about any illnesses.

For the protection of all students, a child with an untreated contagious disease should not be in school. This includes impetigo, pink eye, scabies, head lice, ringworm or excessive sneezing and coughing (as early cold symptoms). A note from the child's physician would be helpful in determining when the child should be re-admitted to school.

Parents are urged to send in a note explaining any illness-related absences.


Immunizations

New York State Public Health Law mandates that, regardless of age or grade, all new pupils show proof of having been immunized against certain diseases before they enter school. The immunizations required are listed on the attached form, “Physical Exam and Immunization Record by Personal Physician.” If your child is not properly immunized, you must provide us with proof that your child is in the process of re-ceiving and completing the immunizations required, or that you claim a medical or religious exemption meeting the following requirements:

  1. Medical exemption - must include a physician's statement that immunization against any one of the diseases would be harmful to the child's health.
  2. Religious exemption - you must provide a written statement that parents or guardians are bona fide member of a recognized organization whose teachings are contrary to the administration of immunizing agents.

Notify the office of any immunizations/boosters that your child receives during the school year so that health records can be kept up to date.

Bring proof of your child's immunizations - available from your physician - to the school as soon as possi-ble. It must be signed by a doctor or nurse in that office. We will accept a faxed or emailed copy of the form. Our contact information is on the front page of this packet.

Your child will not be able to start his/her first day of school unless proof of immunizations or exemptions are on file.


Physicals

New York State requires that all children entering Pre-school, Kindergarten and grades 2, 4, 7 and 10 have a physical examination by their doctor before entering school. You can schedule an exam with your health care provider. If a report of a physical is not received within 30 days of the start of school, we will arrange for one to be done in school by a licensed health care provider.


Mandated Tests

Vision. All new students and students entering or re-entering Pre-K, 2nd, 4th, 5th, 7th, and 10th will have their vision tested at FLCS by the local public school’s nurse.

Hearing. Those students entering or re-entering Pre-K, K, 2nd, 4th, 7th, and 10th will be given a hearing test.

Scoliosis. New York State requires that each child entering or re-entering grades 5-9 receive an annual examination of their back, by the public school nurse, to detect curvature of the spine. For all tests, parents will be notified if the results are questionable or treatment is recommended.


Medications

Over-the-counter (OTC) medications to be taken by a student during the school day require written preauthorization by a parent.

Prescription medications require written pre-authorization by a parent, a copy of the prescription, and must be in the original prescription bottle.

Permission forms for both OTC and prescription medications are included in this application or can be obtained from the office.

Students are not allowed to self-administer any medications, whether OTC or prescription. They are not allowed to have any medications on their person, in their backpack or stored in their lockers. Medications may only be administered by a staff member, and only in the office. Exceptions to these rules are on the permission form.

Students are never, under any circumstances, to give medication of any kind to another student. A first offense will result in a mandatory suspension.


Lead Screening Test

According to New York State guidelines, all pre-school children should have a lead screening test done within three months of school enrollment. While not required, all area doctors are aware of this guideline and usually include the test during the pre-school physical. This is a reminder to check with your child's doctor about this important test.

Medical Information and History

Doctor’s Name*
Doctor’s Phone*
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Were there any issues, pre-natal or during or immediately following birth, that resulted in any effects or complications that FLCS should be aware of in educating or otherwise caring for your child?
Has your child ever had any of the following diseases or conditions?
If you answered yes to any of the above, please provide dates below.
Does your child have allergies?*
If yes, allergic to what and how would you handle an allergic reaction?
Does your child have asthma?*
If yes, describe what triggers an attack, attack frequency, and what medications are given.
Does your child have seizures?*
If yes, describe how often, how long they last, and what medication is taken.
Does your child have frequent earaches or ear infections?*
Does your child have frequent sore throats or strep throat?*
Does your child have Hyperactivity/Attention Deficit Disorder?*
If yes, describe how it is handled or treated (medications, etc.).

If medications are required to handle any of the above conditions, please supply the appropriate medication permissions, found in this application.

Has your child ever had a serious head injury?*
If yes, describe the injury, its date, treatment given, and any lasting effects.
Has your child ever had lead poisoning?*
If yes, when and how was it treated?
Has your child ever had a serious injury or accident?*
If yes, describe and give dates.
Has your child ever had any operations?*
If yes, describe and give dates.
Has your child ever been hospitalized?*
If yes, describe and give dates.
Has your child ever had any uncorrected problem with eyes or eyesight?*
If yes, describe.
Has your child ever had any uncorrected problems with ears or hearing?*
If yes, describe.
Has your child ever had any speech or language problems?*
If yes, was an evaluation done and what was the date and results?
Does your child have any physical disabilities that would limit gym participation?*
If yes, describe.
Has your child ever had any mental health/emotional problems?*
If yes, describe.
Does your child take any medications on a daily basis?*
If yes, describe.
Will your child be taking any medication during school hours?*
If yes, please list the medications and be certain to include the medications in the medication permission area of this application.
If there are any other medical problems not previously listed, please describe.
Are there any other problems pertaining to family life, home, school, social life, etc. that you think we should be aware of?

The above information is considered confidential, but we do occasionally share information with principal, guidance counselors, or teachers as necessary.

Parent/Guardian Authorization for Administration of Non-Prescription (OTC) Medication in School

We will not administer medication of any kind to your child without a parent or guardian’s written consent.  We will only administer the non-prescription (OTC) medications listed on this application.  The school stocks a supply of generic ibuprofen, acetaminophen (Tylenol), cough drops and throat lozenges.  If there are others you want to have available for your child, please bring them to the office, labeled with your child’s name.  Students may not carry medication of any kind on their person at any time, nor keep it in their backpacks, lockers, etc.  There are no exceptions except prescription inhalers or Epi-pens, which may be carried by the student and self-administered.  All other medication in the building must be stored in the office for administration by an authorized staff member.  Students may never, under any circumstances, give medication to another student.  A first offense will result in mandatory suspension.

  1.  Ibuprophen (Advil, Motrin) - Common indications include headache, backache, toothache, muscle pain, menstrual pain, fever due to cold/flu.  Dosage of 200mg tablets, 1-2 given every 4-6 hours.
  2. Acetaminophen (Tylenol - regular strength) - Common indications include headache, backache, toothache, muscle pain, menstrual pain, fever due to cold/flu.  Dosage of 325mg tablets, 1-2 given every 4-6 hours.
  3. Cough drops/throat lozenges - Common indications include cough, sore throat. Given every 1-2 hours or as needed.
  4. Sunscreen - Common indications include expected exposure to the sun.  Given as needed.


Please list other non-prescription medication that you want to provide for your child's use.
Parent/Guardian OTC medication authorization E-Signature*

Prescription Medication Permission Form

The Prescription Medication Permission Form is available as a .pdf here.

A separate Prescription Medication Permission Form for each prescription must be completed by parent or guardian.  Please make copies of this page as necessary.

Students may not carry medication of any kind on their person at any time, nor keep it in their backpacks, lockers, etc.  There are no exceptions except prescription inhalers or epipens, which may be carried by the student and self-administered.  All other medication in the building must be stored in the office for administration by an authorized staff member. Students may never, under any circumstances, give medication to another student.  A first offense will result in mandatory suspension.

Prescription Medication Permission Formsmay be mailed, emailed, faxed, or uploaded to FLCS:

Finger Lakes Christian School
2291 Rt. 89
Seneca Falls, NY 13148

office@fingerlakeschristianschool.com

Fax: 315-568-6638
Upload Prescription Form:

I affirm that all the information I have provided in this application is true to the best of my knowledge.  I understand that false information may result in this application being denied.  I understand that if false information is discovered after enrollment it may be grounds for dismissal.  This application is conditionally accepted in electronic form for the purposes of beginning the enrollment process, but will not be considered complete until you sign it in the presence of the school Principal or Vice-Principal.

Parent/Guardian E-Signature*

The parent/guardian will be asked to sign a hard copy of this student application at the enrollment interview.

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