School Enrollment Form

School Enrollment Application

Immaneul Lutheran

300 S Pathway Court

Crystal Lake IL 60014

815 459 1441

www.immanuelcl.org

Gender of Student*

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Address of Student*

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Address if different from student's address

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Immanuel Lutheran Crystal Lake Alumnus

Address if different from student's address

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Immanuel Lutheran Crystal Lake Alumnus

Marital Status of Parents

Child Lives With

Baptized

Nationality

Class / Grade Level

Please indicate the grade level of the student

Please Check any Health Needs

Learning Difficulties / Disablities

Does your child have any mental, emotional or physical hardships which may affect his/her activities or progress?

Please check if your child has been tested or recommended to be evaluated for the following conditions

Please provide testing information/results if applicable

Does your child take medication on a regular basis for the above conditions?

Does your child have 504 plan or an IEP?

Has your child been retained, suspended or expelled from school?

Will you be using bus service?

Note: Student must live within District 47 to be eligible for bus service

How did your family hear about Immanuel Lutheran Crystal Lake?

Please check all that apply