APPLICATION

Please fill out an application for each child

PDF Application

Download Version

You can fill out this form and email it to MSCS@mineralsprings.net. The $100 per student application fee can be sent to the school office or paid online. You can also choose to print the application, and mail it and the application fee to the school office at 1032 Bible Lane Vinton, VA 24179.

Student Enrollment Form 2025-2026

Please take a moment to fill out the form.

Student Information

Student's First Name

Student's Last Name

Address

Primary Phone Number

Birthday

Parent/Gaurdian Information

Father/ Gaurdian Information

Father's Address

Father's Primary Phone Number

Father's Employment

Father's Work Number

Father's Email

Mother/ Gaurdian Name

Mother's Address

Mother's Primary Phone Number

Mother's Employment

Mother's Work Number

Mother's Email

Student History

Previous School Attended

Last Grade Completed

If yes, please explain.

Has the student ever been suspended or expelled from school? If yes, please provide a brief explanation.

Transportation Information

(Name of persons authorized to pick up student other than above.)

Name and Phone Number and Relationship

Medical Information

Physician's Name

Phone Number

Insurance

Policy Number

Is your child being treated for an injury/condition that requires medication?

Does your child have any food or medical allergies? If so, please list.

Does your child require a special diet? If so, please explain.

Does your child have a physical or medical condition that may limit their ability to participate in rigorous physical activities, including P.E.? If yes, please explain.

Emergency Contacts

(Emergency contacts must not live in the same household as the child.)

Name:

Relationship

Phone Number

Address

Emergency Contact Name

Relationship to child

Emergency Contact Phone Number

Emergency Contact Address

By checking the box agree that I will be notified in the event of a medical emergency involving my child. However, if my child should be injured or become sick and I cannot be reached, I authorize Mineral Springs Christian School’s staff to obtain necessary medical treatment for my child. I understand that Mineral Springs Christian School will not be responsible for any medical expenses incurred, but I will be financially responsible for the treatment.

How did you hear about our school?

Please let us know who or where you heard about our school from.

Thanks for submitting!