Download Report

New Student Application Process
2015-2016
1. Application Materials
The following items are required for a complete application:
1. New Student Information
2. Registration and Tuition Contract
3. Emergency Contact/Permissions Form
4. Immunization Record
5. Birth Certificate
6. Most Recent Report Card
7. If applicable, IEPs or documents outlining your student’s academic accommodations
8. Academic Reference Form
9. Student Questionnaire*
10. Parent Questionnaire*
11. Pastoral Reference Form*
12. Non-Refundable Application Fee ($50)
*Applicable to 7-12th grades only.
2. Family Interview/Screenings
Once your application is complete, including all recommendations and records listed above, we will contact
you to schedule a family interview and any needed screenings ($25 per screening). Administration may require
additional forms to be filled out from your student’s previous school pertaining to their academic ability.
3. Acceptance
After the family interview and assessments are completed, you will be contacted by the Registrar regarding
acceptance.
Admissions Policy
I understand that submitting this application does not guarantee my child’s admission or re-enrollment to
Watersprings School. I certify that all information submitted in the admissions/re-enrollment process is factual,
and I understand Watersprings School will contact me with the admission status of my child. I hereby acknowledge
I have read and understand all the terms and conditions outlined in this form.
Watersprings School admits students of any race, color, gender, national and ethnic origin and grants them all the rights,
privileges, programs, and activities generally accorded or made available to students at the school. The school does not
discriminate on the basis of race, color, national, or ethnic origin in administration of its education policies, admissions
policies, scholarships, athletic and school-administered programs.
Watersprings Church Statement of Faith
Watersprings Church is a non-denominational church focused on the inerrancy of the Bible and the expository
teaching from Genesis to Revelation.

We believe the Bible to be the only inspired, infallible, and authoritative Word of God.

We believe that there is one God, eternally existent in three persons: Father, Son, and Holy Spirit.

We believe in the deity of Jesus Christ; in His virgin birth; in His sinless life; in His miracles; in His vicarious
and atoning death through His shed blood; in His bodily resurrection; in His ascension to the right hand of
the Father; and in His personal return in power and glory.

We believe that for the salvation of lost and sinful man, regeneration by the Holy Spirit is essential, and that
repentance for sin and acceptance of Jesus Christ as Lord and Savior is the only way to come into a
relationship with God.

We believe in the present ministry of the Holy Spirit, by Whose indwelling the Christian is enabled to live a
godly life.
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We believe in the resurrection of both the saved and the lost: they that are saved unto the resurrection of
life and they that are lost unto the resurrection of damnation.

We believe it is important to uphold the Scriptural practices of the early church. Therefore, we hold to the
practice of water baptism and the regular taking of communion. We do not believe that either of these
practices is essential for salvation, but that they serve as a demonstration of our living faith in Christ.
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Today's Date: ___________
New Student Information
2015-2016
Number of Students Enrolling: ___________
1st Student’s Name: ________________________________________ Goes By: ____________ Male: ____ Female: ____
Last,
First
MI
Grade Applying For: _______ Birth Date: _________________ Social Security # ________________
Name of school presently attending: ___________________________ Phone: __________________ Ethnicity: ____________
Has your child been identified as having any of the following?
ADD/ADHD_______ Behavior Disorder_________ Learning Disorder_________ Mental Impairment_________
IEP/504 Plan_____ Physical Impairment_____________ Gifted/Talented___________ Speech/Language_______
Has this child ever been: Suspended? _____ Expelled? _____ Asked to withdraw? _____ Extended Absences? _____
Has this child been held back due to grades? ______ Received any type of special education? ____________________
Has this child ever attended Watersprings School? ____ If so, when? _____________
If yes on any of the above, please explain: _____________________________________________________________
______________________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------------------------------2nd Student’s Name: _____________________________________ Goes By: ______________ Male: ____ Female: ____
Last,
First
MI
Grade Applying For: _______ Birth Date: _________________ Social Security # ________________
Name of school presently attending: ___________________________ Phone: __________________ Ethnicity: ____________
Has your child been identified as having any of the following?
ADD/ADHD_______ Behavior Disorder_________ Learning Disorder_________ Mental Impairment_________
IEP/504 Plan_____ Physical Impairment_____________ Gifted/Talented___________ Speech/Language_______
Has this child ever been: Suspended? _____ Expelled? _____ Asked to withdraw? _____ Extended Absences? _____
Has this child been held back due to grades? ______ Received any type of special education? ____________________
Has this child ever attended Watersprings School? ____ If so, when? _____________
If yes on any of the above, please explain: _____________________________________________________________
______________________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------------------------------3rd Student’s Name: _____________________________________ Goes By: ______________ Male: ____ Female: ____
Last,
First
MI
Grade Applying For: _______ Birth Date: _________________ Social Security # ________________
Name of school presently attending: ___________________________ Phone: __________________ Ethnicity: ____________
Has your child been identified as having any of the following?
ADD/ADHD_______ Behavior Disorder_________ Learning Disorder_________ Mental Impairment_________
IEP/504 Plan_____ Physical Impairment_____________ Gifted/Talented___________ Speech/Language_______
Has this child ever been: Suspended? _____ Expelled? _____ Asked to withdraw? _____ Extended Absences? _____
Has this child been held back due to grades? ______ Received any type of special education? ____________________
Has this child ever attended Watersprings School? ____ If so, when? _____________
If yes on any of the above, please explain: _____________________________________________________________
______________________________________________________________________________________________
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Registration and Tuition Contract
2015-2016
The yearly Registration Fee needs to be paid by JULY 1st. A $50.00 NON-REFUNDABLE deposit of the
Registration Fee is required at the time of enrollment to hold each student’s spot. Registration Fees cover
the cost of the curriculum, testing materials, and all school supplies for the school year. After a student begins the
school year, Registration Fees are non-refundable.
REGISTRATION
Registration Fees
K3 and K4
K5 and 1st grade
2nd through 12th grades
Yearly
$175.00
$275.00
$350.00
Child’s Name
Grade
(Last Name, First Name)
Registration Fee Amount
Grand Total Registration Fee $
Please initial understanding that the Registration Fee is due JULY 1, 2015: __________________________
TUITION
9 Month K3 & K4 Preschool Tuition Schedule
8:30-11:30 for 4 days
8:30-11:30 for 5 days
10 Month School Tuition Schedule
K5-6th Grades
7th-8th Grades
9th-12th Grades
Monthly
$185.00
$225.00
Monthly
Yearly
$310.00
$342.00
$394.00
$3,100.00
$3,420.00
$3,940.00
SCHOOL DISCOUNTS
• $100 discount will be given if the yearly tuition is paid in full at the beginning of the school year.
• Oldest child pays full tuition and any additional children are discounted 20% from their tuition cost.
Child’s Name
(Last Name, First Name)
Grade
Tuition Amount
Minus
Discount
Tuition per Month
Grand Total Each Month $
Please initial understanding that the 10 Month Tuition Payment begins AUGUST 1, 2015: _____________
4250 South 25th East • Phone 208-542-6250 • Fax 208-441-6806
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Registration and Tuition Contract (continued)
Tuition Payments –Tuition payments are due in full on the 1st of each month. If payments are not
received by the 7th, a $10.00 late fee will be assessed to your account. If the account becomes delinquent any time
during the school year, you will receive a letter from our office requiring immediate payment in full on your balance.
If your account becomes 30 days delinquent, we may require you to take your child out of school until the balance is
paid in full. If you do not make the necessary arrangements to satisfy your obligation, we will turn your account
over to Merchants Credit Association. This policy will be strictly enforced.
Returned Check Fee –There will be a $25.00 returned check fee charged to your account if an NSF check is
returned to us by our bank. You will be notified immediately and will need to make up that payment in full with
cash, cashier’s check, or money order only.
I AGREE TO PAY WATERSPRINGS SCHOOL ACCORDING TO THE ABOVE TERMS.
Contracting Family Information
Print Name: _______________________________________ Relationship to Student: _____________________
Address: __________________________________________ City: _____________ State: _____ Zip: ________
Home Phone: _________________ Cell Phone: ________________ Email: _____________________________
Work Place: ______________________ Work Phone: __________________ City: ________________________
Social Security # ________________ Signature: ________________________________ Date: ______________
Print Name: _______________________________________ Relationship to Student: _____________________
Address: __________________________________________ City: _____________ State: _____ Zip: ________
Home Phone: _________________ Cell Phone: ________________ Email: _____________________________
Work Place: ______________________ Work Phone: __________________ City: _______________________
Social Security # ________________ Signature: ________________________________ Date: _____________
Should you, during the term of your agreement, find it difficult to comply for any reason, please contact us at
(208) 542-6250 so that we might discuss payment options.
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Please keep this copy for your records.
PHILOSOPHY OF EDUCATION
Watersprings School's Philosophy of Education is based on four essential areas found in Luke 2:52, which states,
"And Jesus increased in (1) wisdom, and (2) stature and (3) favor with God and (4) men."
1) Intellectual Development: Wisdom (Romans 12:2) we pursue excellence in every subject.
2) Physical Development: Stature (1 Corinthians 3:16-17) We currently offer a challenging physical education
program, as well as multiple extra-curricular programs, including sports such as football, basketball, volleyball,
and golf at the high school level.
3) Spiritual Development: Favor with God (Matthew 22:36-38, Romans 8:29, Acts 2:42, and Matthew
28:19-20) Our mission at Watersprings School is to train our students to be disciples in their walk with Christ.
To meet this goal of preparing them spiritually in their walk with God, we focus on the areas of prayer, Bible
studies, and fellowship. All of our students hear God's Word on a daily basis, are taught how to apply it, and we
model how to live out God's Word from a Biblical perspective.
4) Social Development: Favor with Men (Matthew 22:39-40, 1 Peter 2:17, Matthew 7:12) Our goal is to
produce godly young men and women who grow in their relationships with God, their parents, our staff, fellow
students and others in their community. Our students lead and are actively involved in outreach and servitude.
We focus on important character traits throughout the year (honesty, trustworthiness, etc.) and train our
students how to persevere and do all things with excellence, as unto the Lord.
K5 through 6th Grades
For our K5 through 6th grades, our mission is to come alongside parents in training up their children in the way of
the Lord (Proverbs 22:6). We are a Christ-centered school with Christian educational goals and objectives. We
intend to encourage and enable students to receive all that God has for them intellectually, physically, spiritually,
and socially. We recognize this to be primary responsibility of the parents and for this reason, we believe the close
cooperation of school and family is essential.
7th through 12th Grades
For our 7th through 12th grades we take a discipleship approach in preparing your child to live a life that is pleasing
to the Lord. In these grades we require students to profess Jesus Christ as their Savior and have a personal walk
with Jesus.
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PERMISSIONS PAGE
Agreement to Terms and Conditions of the Student/Parent Handbook(s)
Watersprings School is a Christ-centered, non-denominational school that encourages and prepares its students to grow in
their personal faith in Jesus Christ, to pursue higher education, and to serve the Lord, their families, and their community.
Watersprings School believes that the spiritual growth of its students gives meaning to all their intellectual and physical
endeavors. I fully acknowledge and understand that my child will be taught spiritual truths in accordance with Scripture at
Watersprings School. I agree that my student’s enrollment is contingent upon compliance at all times, with the terms and
conditions of the Student/Parent Handbook(s) applicable to the grade(s) my student(s) are in for this school year.
(Handbooks can be found online at www.waterspringsschool.net.
Authorization for Medical Treatment
I, the parent or legal guardian of the minor child and student of Watersprings School hereby authorize Watersprings School,
their employees and any other adult persons into whose temporary care my child has been entrusted by Watersprings School,
to make any decisions as may be reasonably necessary for the personal care of my child in my absence. Watersprings School
will make reasonable efforts to contact me, and if I am unavailable, those persons listed on my child’s emergency contact form
prior to the authorization of any medical treatment. However, in the event of an emergency, and neither I nor any of those
persons listed on my child’s emergency contact form can be reached, I authorize Watersprings School and other adult persons
into whose temporary care my child has been entrusted by Watersprings School, to consent to x-ray examination, anesthesia,
medical, dental, or surgical diagnosis and treatment, including hospital care deemed necessary for my child upon the
recommendation of and under the supervision of a licensed physician. I acknowledge that I am responsible for all costs
incurred in connection with such emergency medical or dental care for my child and agree to indemnify and hold Watersprings
School and other adult persons into whose temporary care my child has been entrusted by Watersprings School, harmless
from any and all costs arising out of or in connection with such emergency medical or dental care.
Discipline Policy (K5-12th Grades)
When a student’s behavior or attitude is in conflict with the standards of the school, every effort will be made to encourage the
student to demonstrate the change and improvement necessary to comply with these standards. As much as possible,
misbehavior in the classroom will be handled by the teacher. Methods of maintaining student discipline at Watersprings
School may include one or more of the following, at the teacher’s discretion:




The teacher and student will have a meeting regarding the misbehavior.
The teacher may assign a consequence to the student.
The teacher may notify parents of the incident.
The teacher may request a conference to include the parent, teacher, student and Administration.
If the teacher feels that there is a continuing problem in behavior or attitude, the student will be referred to Administration for
further disciplinary action. At that time, the child will be counseled and, if necessary, disciplined further. Believing that God’s
Word best prescribes the appropriate method of correction; the Administrator may use a "swat” to discipline the child
("Foolishness is bound up in the heart of a child; the rod of correction will drive it far from him." Proverbs 22:15 "The rod
and rebuke give wisdom, but a child left to himself brings shame to his mother." Proverbs 29:15). We feel that when used
wisely and correctly, the use of a “swat” is a positive tool for change and growth. Here are some examples of when a swat is
administered: fighting has taken place, an extremely rebellious attitude or disrespect to staff has been displayed, or after a visit
to the Administrator for other behaviors/attitudes. A swat is only administered when other forms of discipline are not
successful in changing the student's behavior. Please refer to the School Handbooks for other means of dealing with
behavioral or attitude issues. Idaho Code 33-1224.
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EMERGENCY INFORMATION
K3 through 12th Grades
2015-2016
Please check one: ____New Student ____Re-Enrollment
Name of Student: _____________________________________________ Birthdate:
/
Preschool Only: Circle the days your student will be in attendance
W
M
T
/
Grade: ___________
TH
F
Emergency Contact Information: (Must include any parental contact information plus two additional contacts.)
1. Name: __________________________Relationship____________ Home#:_____________Cell:______________
2. Name: __________________________Relationship____________ Home#:_____________Cell:______________
3. Name: __________________________Relationship____________ Home#:_____________Cell:______________
4. Name: __________________________Relationship____________ Home#:_____________Cell:______________
Student lives with: (check all that apply) ___Father ___Mother ___Other (Name/Relationship) __________________
Are the student’s parents married? ____________________________________________________________________
Email address(es) where Progress Reports and School Communication should be sent to:
__________________________________________________________________________________________________
Please indicate if there are individuals who CANNOT pick up your child. We must have legal documentation on file
to enforce.
===================================================================
Health History
How would you describe your child’s overall health? _________________________________________________________
Has your child, to your knowledge, used any type of drugs, alcohol, or tobacco? _____ Yes_____ No
If yes, please comment on the circumstances._______________________________________________________________
Check any medical conditions that may apply to your child of which the school should be aware:
___ Asthma
___ Epileptic
___ Chronic Illness
____Diabetic
___ Past Injuries
___ Glasses/Contacts Worn
___Other (please explain) _________________
Allergies: __________________________________________________________________________________________
Current Daily Medication(s):____________________________________________________________________________
*All medications must be checked in, stored and administered in the school office.
===================================================================
Church Affiliation
Where does your family attend church? ________________________________ How often? ________________________
Please describe your family’s involvement in your church: _____________________________________________________
__________________________________________________________________________________________________
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2015-2016
Parent Permission Form
Student Information (Please Print):
First Name: _____________________________ Last Name: ________________________ Gender: [ ] Male [ ] Female
Parents: Please read the following, mark your choices and sign at the bottom.
____Yes ____No
I have read and understand the attached Admissions Policy.
____Yes ____No
I am in agreement with the Statement of Faith, Philosophy of Education, and Student/Parent
Handbook(s). Handbooks can be accessed online at www.waterspringsschool.net.
____Yes ____No
I have read, understand and agree to the Authorization for Medical Treatment.
____Yes ____No
I give permission for my child to attend field trips.
____Yes ____No
I give permission for pictures/video of my child to be used in media pertaining to Watersprings
School, including use of images on our Facebook page and school website.
____Yes ____No
I give permission for my family name, phone numbers, email, and student school photo to be listed
in the school directory (available to ALL parents via RenWeb).
____Yes ____No
Please enroll my child in the before/after school childcare program (K3-5th grade). The cost for
daycare is $3.25 per hour for the first child and $2.60 per hour for each additional child.
____Yes ____No
I give permission for my child to receive texts and emails from Watersprings School (7th-12th grades).
Student phone_____________________ Student email___________________________________
____Yes ____No
I have read and understand the Discipline Policy (K5-12th grades) and hereby give consent for
Watersprings School to administer discipline to my child. Should a swat be necessary, an
administrator will contact the parent.
_________________________________________________
Parent Signature
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__________________
Date
About Watersprings School
Watersprings School, originally known as Calvary Chapel Christian School, was started in the fall of 1997 with the
desire to provide the members of Watersprings Church and the Christian community of Idaho Falls with a Christcentered school that could disciple the children of believers in the ways of Jesus Christ. With the Lord Jesus Christ
as our example and main focus, our desire is to work alongside you, the parents, to provide a nurturing Christcentered school, address education from a Christian perspective, and allow our students the opportunity to
understand themselves and the world around them.
Logistics & Ratios



Enrollment – Over 400 students are enrolled at Watersprings School between K3-12th grades.
Facilities – K3-6th grades located at the Elementary Campus (4250 S. 25th E), 7th-12th grades located at the
Jr. High/High School Campus (665 John Adams Pkwy).
Student-to-Faculty Ratio – 16:1 for Elementary, 18:1 for Jr. High and 10:1 for High School.
Office Hours
Elementary Campus 8:15-3:45
Jr. High/High School Campus 8:00-4:00
School Hours
Elementary Campus 8:30-3:00
Jr. High/High School Campus 8:15-3:40
Preschool Hours
K3 and K4 8:30-11:30
Educational Affiliation/Accreditation
Watersprings School is a member of ACSI. Our Jr. High/High School is accredited through ACSI and Advanced
ED, the same organization that accredits our local public schools.
Payments
School/Daycare Payments can be made by cash or check at the either School Office. We accept Visa, MasterCard,
Discover, credit or debit cards but there will be a fee charged for each transaction. You may also pay online
through RenWeb (please note, Visa cards are not accepted online).
RenWeb
You can use our online system to make payments, purchase school lunches, update personal information, access
documents and schedules, view grades and lesson plans and email any of your child’s teachers. You can access this
via www.renweb.com or through a link on our school website www.waterspringsschool.net. You will need to enter
our District Code, which is CC-ID, and then you will be able to create your own Username and Password. Please
call the Elementary Campus at (208)542-6250 or the Jr. High/High School Campus office at (208)932-0210 if you
need assistance.
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Daycare
 Ages – K3-5th Grades
 Cost – $3.25 per hour for the 1st child and $2.60 per hour for each additional child.
 Hours – 7:15AM until school starts and after school until 6:00PM.
Daycare invoices will be sent home every 2 weeks via email. If you would like a paper statement, you may come into
the office and request one.
Lunch Program
Both of our campuses offer nutritional and affordable lunches. Hot lunch (including milk) costs:
 Elementary Campus: $3.00 a day, and milk alone is $.35.
 Jr. High/High School Campus: $3.25 a day, and milk alone is $.35.
Athletics
Watersprings School is a member of the IHSAA (Idaho High School Activity Association). Sports currently offered
for our Jr. High/High School athletes are:
 Football
 Volleyball
 Girls and Boys Basketball
 Golf (High School Students Only).
For information, practice times and game schedules please go to www.warriorpride.net.
School Supplies
The annual registration fee pays for all standard school supplies for your student. Any other supplies will be
communicated by your student’s teacher. Your student will need to bring a backpack.
School Website
For your convenience, the below information can be found on our school website at www.waterspringsschool.net.
 Online Registration/Tuition Information
 School Calendar
 Lunch Menus and Costs
 Student/Parent Handbooks for K-6th and 7th-12th Grades
 Sports Info
 Pictures of Events and Activities
 And much more!
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Academic Reference Form
Student’s Name:
Do you personally know this student?
Your relationship to this student:
How long have you known this student?
In which subject(s) have you instructed this student?
Please rate the following:
Poor
Fair
Good
Academic ability
Academic performance
Attendance
Creativity
Emotional stability
Independence
Parental involvement
Respect for peers
Respect for teachers
Self-control
Study habits
Please describe this student’s behavior in the classroom:
Briefly describe this student’s personality:
What are this student’s strengths?
What are this student’s weaknesses?
Please see reverse side for additional questions
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Excellent
Unknown
What is this student’s attitude toward school?
To your knowledge, has this student had a history of drug, alcohol, or juvenile delinquency
problems?
If yes, please explain.
To your knowledge, has this student had a history of conduct or behavior problems?
If yes, please explain
Does this student have a history of a learning disability or has he/she required any special
help to meet academic requirements?
If yes, please explain
On the basis of your knowledge of this student….
Additional comments, if desired:
Signed:
Name (please print):
School Name:
School Address:
City:
Date:
Title:
School Phone:
School Email:
State
Zip
Please note that this information will remain confidential.
This completed reference form should be faxed to (208) 932-0225 or mailed to
Watersprings School
665 John Adams Parkway
Idaho Falls, ID 83401
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Student Questionnaire
Grades 6th-12th
Name: ____________________________
Date: ______________
To be handwritten by Student
1. Have you personally received Jesus Christ as your Savior? If so, write your personal testimony in a few paragraphs.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
2. If you have not received Jesus Christ as your Savior, are you open to the message of salvation through Christ? _________
3. Where do you attend church? _____________________________ How often do you attend? _____________________
4. Do you attend youth group? ______________________________ How often do you attend? _____________________
5. Do your closest friends attend church regularly? _________________________________________________________
6. What is your definition of a Christian? ________________________________________________________________
__________________________________________________________________________________________________
7. Write a brief statement explaining what you believe about the Bible__________________________________________
__________________________________________________________________________________________________
8. Is it your personal desire to attend Watersprings School? If so, why? _________________________________________
__________________________________________________________________________________________________
9. What are some of your interests, hobbies, or favorite activities? _____________________________________________
__________________________________________________________________________________________________
10. Have you held any offices at church or school? If so, what? ________________________________________________
11. What subjects are challenging for you? ________________________________________________________________
12. Have you ever been absent from school for a long period of time? If yes, please explain. __________________________
__________________________________________________________________________________________________
13. Have you ever had difficulty with teachers or fellow students in a previous school? If yes, please explain.
__________________________________________________________________________________________________
14. Finally, what else would you like us to know about you as we consider your application?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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Parent Questionnaire
Grades 6th-12th
Parent Name(s): ____________________________
Date: ______________
Thank you for applying to Watersprings School! Our Junior High and High School are discipleship in nature, so please take a
moment to answer the following questions in preparation for your interview with us. Please use additional paper if necessary.
1. Why do you believe Watersprings is the best choice for your child?____________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
2. Describe the spiritual health of your family. Include information about church and ministry involvement and family
devotions__________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
3. Tell us about any significant events in the social, emotional, or physical development of your child. Please include any
potential special needs required in an academic setting _______________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
4. Briefly describe your child’s experience at previous schools __________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
5. Has your child ever been suspended or expelled? If yes, please explain _________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
6. Has your child ever had any interaction with law enforcement? If yes, please explain _____________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
7. Please feel free to include any other information you would like us to consider as part of your application_______________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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Pastoral Reference Form
(To be filled out for each student)
Student’s Name:
Parent’s Name:
Does this student attend your church regularly
Which of this student’s family members, including the student, are Christians (have made a public
profession of faith)?
Does the student actively participate in your church (youth camps, mission trips, etc.)?
On the basis of your knowledge of this student….
I recommend this student without reservation.
I recommend this student with reservation.
I cannot recommend this student at this time.
Additional comments, if desired:
Signed:
Date:
Name (please print):
Title:
Church Name:
Church Phone:
Church Address:
Church E-Mail
City:
State
Zip
Please note that this information will remain confidential.
This completed reference form should be faxed to (208) 932-0225 or mailed to:
Watersprings School
665 John Adams Pkwy
Idaho Falls, ID 83401
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