Today's Date *
Today's Date
Name of Applicant *
Name of Applicant
Sex *
U.S. Citizen?
Address 1 *
Address 1
Home Phone *
Home Phone
Father Work/Cell *
Father Work/Cell
Mother Work/Cell *
Mother Work/Cell
Name of Guardian *
Name of Guardian
Address of Last School Attended *
Address of Last School Attended
Is This Child a Member of a Church? *
Physician Phone *
Physician Phone
I Understand the Objectives and Regulations of the Berkshire Hills Christian School and Pledge our Full Support: *