Online Application


Your Name*

Student Information

Student Name*

Address*

School District*

Gender* malefemale

Age*

Birthday*

Home Phone

Parent Cell Phone

Student Cell Phone

Parent Email*

Student Email

School Last Attended*

School Address

Last Grade Completed*

Family Information

Father's Name

Legal Guardian? yesno

Employer

Position

Business Phone

Mother's Name

Legal Guardian? yesno

Employer

Position

Business Phone

Marital Status*
MarriedDivorcedWidowedSeparatedSingle

Other children in the family (name and age):

Medical Information

Family Physician*

Phone

Allergies*

Please have your doctor complete the Medical Exam Form and submit it with your application.

Church Background

Do you regularly attend Church?*
Father yesno
Mother yesno
Student yesno

If yes, what church do you regularly attend?

Are you a member?*
Father yesno
Mother yesno
Student yesno

Has applicant ever made a profession of faith in Christ?* yesno

If you attend a church besides Lighthouse Baptist Church, please have your pastor mail or email a recommendation letter directly to the school.

Scholastic Information

Has the student ever been expelled, dismissed, suspended, or refused admission to another school?* yesno
If yes, explain:

Has the student had chronic disciplinary difficulty at school?* yesno
If yes, explain:

Does the student have a juvenile or arrest record?* yesno
If yes, explain:

Has the student ever used tobacco or nonprescription drugs of any kind?* yesno
If yes, explain:

General Information

How did you hear about this school?*

Reason for selecting this school:*

We must have the following before your application can be processed:
1. This completed application
2. The pastor's recommendation
3. Medical Exam Form
4. An interview with the parents and the student
5. Nonrefundable registration fee of $50
After completion of these items, your application will be reviewed for final acceptance.

Contact

Steven Jaggard, Principal

(717)292-5000

lcs@lighthousebap.org

5005 Carlisle Road
Dover, PA 17315