Application For Enrollment Logo

  • Application For Enrollment

    Preschool-8th Grade
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  • First name child will go by in class (if different from legal name):     
    Referred by:       

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  • Students Education Information

  • Parental Information

  • Other Siblings in the Home
    Name:         Age:             
    Name:         Age:      
    Name:         Age:        
    Name:         Age:        

  • Please Note:  The school office must be notified in writing about restrictions regarding who may NOT take the student from the school premises!

  • Church Affiliation

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  • Student Health/Emergency Form

  • Other Medication (Supplied by the Family)
    Medication         mg      Times per day        
    Medication         mg      Times per day   
    List of all Medication the student is taking                     

  • Medical Insurance: All students attending Calvary Lutheran School are recommended to have adequate medical insurance coverage. The school office does not assume responsibility for such coverage. Providing the insurance company and policy number is optional, but will expedite medical treatment in an emergency.
    Insurance Company:      Policy Number:

  • Medical Treatment: If your child should become ill while in school, the school will contact the parent/guardian (or an emergency contact). In an emergency situation, the school may call an ambulance and your child will be treated or transported to a hospital.
    Physician Name:      Phone Number:             
    Dentist Name:          Phone Number:          
    Preferred Hospital:     

  • Emergency Contacts (Someone that doesn't live in the same household)
     *   *     *   *   
    Relationship to student: *
    *   *   *   *   
    Relationship to student:   *   

  • Medical Release:  I do hereby give my permission and/or consent to the personnel of Calvary Lutheran School, 6111 Shelby St. Indianapolis, IN 46227, to secure and authorize such emergency medical care and/or treatment as my child(ren) might require while under the supervision of said Calvary Lutheran School personnel.  I also agree to pay all costs and fees contingent on any emergency medical care and/or treatment for my child(ren) as secured or authorized under this consent.  I understand that this consent will apply to all emergency situations present and future, and that a copy of this form is as valid as the original.  This consent is to remain in effect until written revocation is received.  The information on this form is correct.

  • Clear
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  • Clear
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  • Please submit this information with your Application

  • Please deliver all remaining documents as soon as possible to expedite your applications.

    You may drop off forms in the school office (Door 4 in the south parking lot), email them to our Admissions Director at admissions@thecalvaryschool.org, or fax them to 317-789-3039.

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