- Pilgrim School Chicago

Child's Name *

Preferred Name *

Child's Birthdate *

Child's Sex *

Child's Preferred Pronouns *

Is there any language other than English spoken at home? If so, which language(s)? *

Date Child Will Enter Pilgrim *

Grade of Interest *

Name of Current School *

Start Date at School *

School Address *

School Phone *

School Email *

Reason(s) for Leaving *

Does your child have an active Individualized Educational Plan (IEP) or a 504 plan? If yes, please explain. *

Has your child done neuropsych testing? If yes, please explain. *

Is your child receiving any of the following services? Please check all that apply. *

Please expand on your answer(s) above.

Parent 1 Name *

Parent 1 Preferred Pronouns *

Parent 1 Street Address *

Parent 1 City, State, Zip Code *

Parent 1 Phone *

Parent 1 Work Phone (if applicable)

Parent 1 Email *

Parent 1 Occupation & Place of Employment (if applicable)

Parent 1 Church (if applicable)

Parent 2 Name *

Parent 2 Preferred Pronouns *

Parent 2 Street Address *

Parent 2 City, State, Zip Code *

Parent 2 Phone *

Parent 2 Work Phone (if applicable)

Parent 2 Email *

Parent 2 Occupation & Place of Employment (if applicable)

Parent 2 Church (if applicable)

With which parent(s) does the child reside? *

Who will be responsible for payment of tuition? *

Names and Birthdates of Siblings (if applicable)

Have you taken a tour of Pilgrim? If yes, please enter the date of your tour. *

Why do you feel Pilgrim would be a good fit for your family? *

How did you learn about Pilgrim? *

Is there anything else you'd like to share about your child at this time?