Pinecrest School Application for Admission

-This form is one per student, not one per family.

-Please respond with accurate information.

-An asterisk means it is a required field.

-Please have all information ready at hand to complete all spaces on this form before beginning.

-No space can be left blank.

-Please type N/A if not applicable.

-Once you click "Submit," the form is no longer accessible to you and cannot be edited.

-Please contact admissions@pinecrestschool.org with questions.

Applicant Information

Child's First Name *

Child's Middle Name *

Child's Last Name *

First Name to be Called at Pinecrest *

Applying to Grade *

Applying for *

Current T-Shirt Size *

Gender *

Child Date of Birth (_ _ month / _ _ day / _ _ _ _ year) *

Child's Home Street Address *

City *

State *

Zip Code *

Home Phone (_ _ _ - _ _ _ - _ _ _ _) *

Child's Current Grade *

School Child Currently Attends *

School Street Address *

City *

State *

Zip Code *

Phone (_ _ _ - _ _ _ - _ _ _ _) *

Parent/Guardian Information

-Please type N/A if not applicable.

-Parent/guardian listed as Parent/Guardian 1 will be contacted first should any needs arise.

Parent/Guardian 1 First & Last Name *

Relationship *

Parent/Guardian 1 lives at the same address as the child. *

Parent/Guardian 1 Occupation *

Parent/Guardian 1 Street Address, City, State & Zip Code if different from Child's Address Entered Above

Parent/Guardian 1 Mobile Phone (_ _ _ - _ _ _ - _ _ _ _) *

Parent/Guardian 1 Work Number (_ _ _ - _ _ _ - _ _ _ _) *

Parent/Guardian 1 Email Address *

Parent/Guardian 2 First & Last Name *

Relationship *

Parent/Guardian 2 lives at the same address as the child. *

Parent/Guardian 2 Occupation *

Parent/Guardian 2 Street Address, City, State & Zip Code if different from Child's Address Entered Above

Parent/Guardian 2 Mobile Phone (_ _ _ - _ _ _ - _ _ _ _) *

Parent/Guardian 2 Work Number (_ _ _ - _ _ _ - _ _ _ _) *

Parent/Guardian 2 Email Address *

Applicant Lives With (check both if applicable) *

Parent/Guardian 1

Parent/Guardian 2

If parents are separated or divorced, who should receive school correspondence? (check both if applicable) *

Parent/Guardian 1

Parent/Guardian 2

Not Applicable

If parents are divorced, who has legal custody of the applicant? (check both if applicable) *

Parent/Guardian 1

Parent/Guardian 2

Not Applicable

How did you hear about Pinecrest School? *

Other Information

Please type N/A if not applicable.

If your child has had any educational or psychological testing, other than for admission at another private or independent school, please give date and reason, and send Pinecrest School a copy of the results. *

Please let us know any pertinent medical facts (such as allergies, conditions, physical impairments, and/or treatment for emotional concerns) as well as relevant family information (such as adoption, divorce, family relocation, or illness of sibling(s)). *

Parent/Guardian Comments

Please type N/A if not applicable.

What is your child's attitude towards school? *

How do you think your child is doing in school? *

What are your child's interests outside of school time? *

What are some qualities that you appreciate most about your child? *

What are some areas in which support may be needed? *

What qualities about Pinecrest School make you believe that it would be a good place for your child? *

Application Fee

Pinecrest School admits students of any gender, race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students in the school.

Pinecrest School does not share families’ contact information with third parties.

Application Fee *

$75 Application Fee (non-refundable, non-transferable) - 1 child

The applicant is a former student, a Pinecrest Pavilion or Virtual Pinecrest camper, or the sibling of a current student. *

yes

no

Coupon Code

Type Name for Parent/Guardian Signature *

Today's Date *