WHCS Registration Form GENERAL INFORMATION Please check the information below and make any necessary changes. This information is needed for the school register and cumulative folders. Since these are legal documents, they need to be kept updated. Rest assured that all information submitted shall remain strictly confidential and will be shared with no one other than school officials with a need to know. Thank you for taking the time to make this form as complete as possible. Pupils full name Birth date Birth place Next grade child will be entering Name of last school attended Is the student baptized? Yes No If yes, date of baptism Place baptized Place of membership Father's name Mother's name Student's home address Student's mailing address if different from above Phone number Do you anticipate needing after school care? Yes No PARENT INFORMATION Father Father's address if different from above Father's phone Father's work phone Father's cell phone Father's occupation Father's church affiliation Father's citizenship Father's place of birth Language spoken at home Father's highest level of education completed Elementary school High school Technical school Associates Degree Bachelors Degree Masters Degree PHD Degree Mother Mother's address if different from above Mother's phone Mother's work phone Mother's cell phone Mother's occupation Mother's church affiliation Mother's citizenship Mother's place of birth Language spoken at home Mother's highest level of education completed Elementary school High school Technical school Associates Degree Bachelors Degree Masters Degree PHD Degree EMERGENCY CONTACT INFORMATION: In case of emergency, we may call Relationship Home phone Work phone Family doctor Family doctor's phone Does your child have an IEP, Individual Education Plan? Yes No Email Address MY CHILD MAY BE: (PLEASE CHECK ALL THAT APPLY). Videotaped or to have pictures taken for student teacher evaluation Yes No Photographed for the school year book? Yes No Photographed for the school web site Yes No Included in the student directory with their name, parent's name, address and phone number Yes No THIS DIRECTORY IS GIVEN TO EACH FAMILY AT THE BEGINNING OF THE YEAR If all the information is correct, please sign below. (Please be advised that this equates to your official electronic signature) Signature Date signed Submit WHCS FINANCIAL QUESTIONNAIRE: 1. Parent/Guardian Name(s): 2. Student's Name(s): 3. Home Address Afghanistan Albania Algeria Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr. Bonaire (Dutch Caribbean) Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Isl. & Mcdonald Isl. Vatican City State Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, D P R Korea, Republic of Kuwait Kyrgyzstan Lao People's D R Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, Former Y R of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, O Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent & Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & S S Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States M O Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 4. Billing Address (if different from above) Afghanistan Albania Algeria Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr. Bonaire (Dutch Caribbean) Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Isl. & Mcdonald Isl. Vatican City State Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, D P R Korea, Republic of Kuwait Kyrgyzstan Lao People's D R Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, Former Y R of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, O Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent & Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & S S Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States M O Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 5. Cell Phone: 6. Land Line: 7. Check all that apply: Non-Adventist Adventist Constituent Adventist (Member of the Gardner or Fitchburg Church. Non-Constituent Adventist (Member of some other Adventist Church) 8. Do you plan to apply for the SNEC 3-way plan? If so, please check out the eligibility requirements on the school web site. Yes No 9. Do you anticipate needing assistance from the WHCS Scholarship Fund? Please be advised that availability of funds is limited and reserved for the neediest. Fulfillment of requests is subject to school board vote based on perceived need with Adventist affilitation taking preference. Generally, scholarships are limited to $50/student/mth. Yes No 10. Do you expect to receive financial assistance from any other source Yes No Sponsor source: 11. Would you be willing to receive your monthly statements via email to help us defray the cost of mailing them? Please email me I would prefer a hard copy mailed 12. I would like to request special consideration in paying my tuition based on the following agreement (for example, pay with my income tax refund). Submit