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Troy Holiness School

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Home
About
Our Staff
History
Admissions
Schedule
Donate
Gallery
Contact

Apply Now

Home
About
Our Staff
History
Admissions
Schedule
Donate
Gallery
Contact

Apply Now

Thank you for your interest in Troy Holiness School!

Required application paperwork:

1. Complete application.

2. Sign Record’s Release for THS to obtain the student’s records.
3. Take the diagnostic test.
4. After these points have been completed, the acceptance decision will then be made.
5. Copies of the child’s birth certificate and current immunization records need turned into the office.

Download Application

View Tuition

Parent/Guardian Name

Student Name

School Currently Attending

Grade Currently in School

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Birthday

How did you hear about THS?

Admission Registration Form

CHILD INFORMATION

Child's Full Name

Nickname

Birthdate

Current Age

GenderMaleFemale

Address

City

ZIP Code

PRESCHOOL ONLY:

FIRST NAME YOU WOULD LIKE YOUR CHILD TO LEARN/RECOGNIZE/WRITE(i.e., If your child's name is Elizabeth, do you want her to learn "Elizabeth" or "Liz"?)

Is your child FULLY potty trained?YesNo

Does your child wear underwear daily?YesNo

Does your child drink from a regular cup?YesNo

Does your child feed themselves?YesNo

Is your child a picky eater?YesNo

Does your child nap?YesNo

How long?

PARENT/GUARDIAN INFORMATION

Mother's Name

Cell Phone

Address(if different from the child's)

City

ZIP Code

Email Address

Church you attend or N/A

Employer

Work Number

Father's Name

Cell Phone

Address(if different from the child's)

City

ZIP Code

Email Address

Church you attend or N/A

Employer

Work Number

Which parent/guardian should we contact first with sickness:

Is there a custody agreement or court action involving the child?YesNo(If yes, please submit a copy of custody papers with this form)

Upload file

No file chosen

EMERGENCY CONTACT/AUTHORIZED TO REMOVE CHILD FROM FACILITY (OTHER THAN PARENT)

If your child needs to be picked up by someone other than those listed below, please contact the school before 1 PM. Your primary contact MUST have a full address.

PRIMARY CONTACT (OTHER THAN PARENTS)

Name

Relationship

Address

City

ZIP Code

Cell Phone

Work Number

APPROVED TO PICK-UP CHILD (OTHER THAN PARENTS AND PRIMARY CONTACT)

Name

Relationship

Cell Phone

Other Phone

Name

Relationship

Cell Phone

Other Phone

Name

Relationship

Cell Phone

Other Phone

INDIVIDUALS WHO ARE NOT APPROVED TO PICK UP CHILD

Name

Relationship

Cell Phone

Other Phone

Name

Relationship

Cell Phone

Other Phone

Name

Relationship

Cell Phone

Other Phone

HEALTH INFORMATION

Please Check All That ApplyMy child has no known health concerns.Has your child ever been diagnosed with a learning disability, developmental delay, or behavioral concern? If yes, please explain:Does your child have an IEP? If yes, please explain:Does your child take any medication daily? If yes, please explain:

Learning disability, developmental delay, or behavioral concern Explanation

IEP Explanation

Medication Explanation

Does your child have a history of the following:

Vision ProblemsYesNo

Hearing ImpairmentsYesNo

AsthmaYesNo

Speech ProblemsYesNo

Ear InfectionsYesNo

Dental IssuesYesNo

DiabetesYesNo

Heart Problems.YesNo

Any additional information that Troy Holiness needs to know about your child?

Has your child been screened by Parents As Teachers in your school district?YesNo

If yes, were any concerns brought to your attention?

Does your child receive special services (speech, behavior modification)?YesNo

AUTHORIZATION FOR EMERGENCY TREATMENT OF MINOR CHILD

I understand that I will be notified at once in case of an emergency (accident or injury) with my child, and I will make arrangements for medical care of my child with the physician or hospital of my choice. If I cannot be reached to make necessary arrangements, or in a critical emergency requiring medical care, I authorize Troy Holiness School to contact the following and agree to pay for the services rendered by the hospital and physician:

Doctor/Clinic:

Phone

Preferred Hospital:

Phone

Dentist:

Phone

Signature of Legal Guardian (Dad)

Signature of Legal Guardian (Mom)

AUTHORIZATION FOR NON-PRESCRIPTION MEDICATIONS

Authorization form for the administration of non-prescription medications, including but not limited to sunscreen, insect repellent, Tylenol, and antibacterial cream.

The Authorization Form must be completed for each non-prescription medication.

I authorize Troy Holiness staff to administer the following non-prescription medications for my child, as described below. I understand that these products will only be applied according to the product's label. Any deviations from the label will require a physician's written authorization.

This authorization is valid for one year. Upon expiration, place in the child's file.

PARENT/GUARDIAN SIGNATURE

Date

CHILD

AGE

WEIGHT

Non-Prescription MedicationTylenolAntibacterial OintmentHydrocortisoneAllergy MedicationInsect Repellent (Parent must provide)Sunscreen (Parent must provide)Other

Other Non Prescription Medication

PERMISSIONS & AGREEMENTS

PERMISSIONS

Photos/Video

I permit Troy Holiness School to use photographs for any legal use, including but not limited to publicity, copyright purposes, illustration, advertising, and web content. (This includes video) I understand that no royalty fee or other compensation will become payable to me or Troy Holiness School for such use.YesNo

Field Trips

I permit field trips/excursions. I understand I will be notified in advance when they are planned.YesNo

AGREEMENTS

I am aware that I need to provide an immunization record or immunization exemption form.
When my child is ill, I understand and agree that he/she will not be able to attend until fever-free for 24 hours.
I understand my child MUST be toilet-trained.
I have read all the policies for Troy Holiness School, and I agree to abide by them.
I understand that I must pay the monthly tuition even if my child has absences during the month.
I understand no refunds will be given except in special circumstances.
I understand that the teaching in my child's class will reflect the teaching of the Bible.
I will immediately notify the school if my child is diagnosed with any childhood disease or contagious illness.

Signature of Legal Guardian (Dad)

Date

Signature of Legal Guardian (Mom)

Date

Welcome to Troy Holiness School. We would love to talk to you about your options for your child’s education. Please take the time to look through the information and contact us with your questions.

Home
About
Our Staff
History
Admissions
Schedule
Donate
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Contact

Quick Links

Grades:  
Preschool – 8th Grade

Curriculum:
Accelerated Christian Education (ACE)

Principal:
Hayden Gordon

Established: 
1973

Contact Information

Phone:  
(636) 528-7725

Email:  
troyholinessschool@gmail.com

Address:
1220 Main St,
Troy, MO 63379

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