Application for Admission (K-12)

School Year: -

Today's Date:

Canterbury Kids (age 2 by Aug. 1)	Cavaliers (age 3 by Aug. 1)	Junior Kindergarten (age 4 by Aug. 1)
AM (8:15-11) PM (12:30-3:15)	AM (8:15-11) PM (12:30-3:15)	AM (8:15-11) PM (12:30-3:15)

First: Middle: Last:

Nickname:

Address:

City: State: ZIP:

Phone:

Date of Birth:

	Parent (or guardian)	Parent (or guardian)
Name in Full:
Address: if different from above
	City:	City:
	State: ZIP:	State: ZIP:
Home Phone:
E-mail:
Fax:
Employer/Position:
Business Address:
Business Phone:

If parents are separated, with whom does the student live?

If separated, which parent will assume financial responsibility for the applicant?

Applicant's Current School Program:

Address:

City: State: ZIP:

Telephone:

School Administrator:

Please list any relatives who attend, or have attended, Canterbury School:

Canterbury School was recommended by

If the applicant requires special accommodations, please identify them.

Notes

A $35 nonrefundable deposit must accompany this application form. This application is merely a statement of intent, not a contract.
Tuition for the academic year is established by February 1.
The contract will be due 14 days after the date of issue.
A $450 nonrefundable deposit will be required with the returned student contract. This deposit is part of the total tuition due.

Please press the reset button to clear the application or the submit button to submit your application.

Thank you for your interest in Canterbury School! Please feel free to contact the following for more information.

Paula Pritchard
Admissions Office
Canterbury School
5601 Covington Road
Fort Wayne, IN 46804
(260) 432-7776
Fax (260) 436-9069