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North Country School

Online Application

Please fill out the application below, then download the reference forms and have them returned to us.

APPLICANT INFORMATION

	Student's name in full*

	Name student wishes to be called*

	Applying for grade*

	Home address*

	Male or Female*

	Date of birth*

	Place of birth*

	Social Security Number*

	Home telephone*

	Fax

FAMILY INFORMATION

	Parent/Guardian*

	Name of spouse/partner

	Address (if different from student)

	Telephone*

	Cell phone

	E-mail

	Name and address of workplace*

	Position/title

	Work phone

	Work e-mail

	Fax

	If parents are divorced, with whom is the applicant living?

	Who is the legal guardian?

	Who is financially responsible for the applicant?

	Address

	Phone number

	E-mail

	Parent/guardian

	Name of spouse/partner

	Address (if different from applicant)

	Telephone

	Cell phone

	E-mail

	Name and address of workplace

	Position/title

	Work telephone

	Work e-mail

	Fax

	Siblings- name, age, and school presently attending. Please list all

GRANDPARENTS: (Grandparents often enjoy receiving school publications with news of their grandchildren. If you would like to add them to our mailing list, please provide their names and addresses here.)

	Maternal grandparents names

	Address

	Occupation

	Paternal grandparents names

	Address

	Occupation

	Please list the name and address of any additional extended family members whom you'd like us to put on our mailing list for Organic Roots, the school's bulletin

SCHOOL INFORMATION

	Name and address of applicant's current school*

	Telephone*

	Website or e-mail contact information

If the applicant previously attended any other schools or summer schools in the last two years, please list them with addresses and dates of attendance.

	Dates

	Name

	Address

	Dates

	Name

	Address

INFORMATION ABOUT YOUR CHILD To help us know your child, please give us your frank and complete responses to the following:

	Please describe your child's birth and development through the preschool years*

	What is your child's place in the family?*

	What are your child's strengths - what does your child love most to do and does best?*

	What are your child's weaknesses - areas of growth, things that this child likes least and does least well?*

	What are your goals for your child?*

	Has your child repeated a grade in school?*

	If yes, what grade?

	Has your child attended overnight camp?

	If yes, for how many weeks?

	Name of camp

	Location

Has your child recently experienced

	night terrors
	bedwetting
	homesickness
	sleepwalking
	encopresis
	an allergic reaction (specify below)

	Other problems to which we should be sensitive? What is your advice to us about helping your child deal with these problems?

	Please describe any circumstances in your child's home, family, school, or environment, which may have had supportive or negative effects on his or her personal and school life.

	Has your child ever had any serious physical problems, illnesses, or injuries? If so, please describe and give the ages when these occurred.

	If your child has received any counseling or comprehensive educational testing in the last three years, please send a copy of the most recent assessment.

	ADDITIONAL COMMENTS: Please add any information you think would help us in reaching a decision on admission or in helping your child as a student at North Country School.

GENERAL INFORMATION

	How did you hear about North Country School?

	If a relative or friend has attended North Country School or Camp Treetops, please give the name and approximate year(s).

	To whom should school reports be sent?

	To whom should school mailings (clothing lists, travel sheets, etc) be sent?

	To whom should school billings be sent?

	Do you wish to apply for financial aid?

EMERGENCY CONTACT INFORMATION

If parents/guardians are unavailable in an emergency, contact:

	Name

	Address

	Phone

	Alternate phone

	Relationship to child

	Person completing this application

	Date

If you would like a copy of this submission, please put your email address in the field below.

Please Note: Questions marked with an asterisk (*) are required.

4382 Cascade Rd | Lake Placid, NY 12946 | Ph 518 523 9329 | F 518 523 4858