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