Enrollment Form, Page 1
Name of Child: (as it appears on Birth Certificate)
Last Name:
First Name:
Middle Name:
Address:
City:
Zip Code: 		- -
Phone Number:

Child's legal name if different from above:

Birth Date
Birth Certificate Number:

Father's Last Name:
First Name:
Middle Initial:
Occupation:
- -
Business Phone:
Email Address:

Mother's Last Name:
First Name:
Middle Initial:
Occupation:
- -
Business Phone:
Email Address:
Names and Ages of Siblings:
years
years
years
years
Nursery Schools Attended:
Check and explain any items for which your child has difficulty:
Please Select All That Apply





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Jubilee Christian School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs


Jubilee Christian School ~ 255 Washington Road, Mt. Lebanon, PA 15216  
Phone: 412-561-5917  ~  Fax: 412-561-2857
E-Mail: judi.phelps@jubileechristianschool.org