Online Enrollment Application

2019-2020 Enrollment Application

Grade in 2019-2020  

Student Last Name   

Student First Name 

Student Middle Name   



Address Line 1 

Address Line 2 

City   State  

Zip Code 

Household Phone Number  

Student Cell Number 

Lives with Mother? Father? Both Parents? Guardian? Choose One  

Mother or Legal Guardian Name  

Phone Number  


City    State  


Employer   Work Number  

Cell Phone  

E-Mail Address 

Father or Legal Guardian 


City   State  


Employer   Work Number 

Cell Phone   

E-Mail Address 

Doctor   Doctor's Phone  

Emergency Contact  

Relationship to Student 

Emergency Phone Number 

School Attended Prior to LHS-KC  

Phone Number  

School District in which student resides 

Church Student Attends 

Ethnic information is used for school data base research purposes only.  Please choose the one which best describes your child.    

African American/Native American/Asian/Hispanic/Caucasian 

Does your student has a documented diagnosis that may affect future learning and/or testing ? Yes/No


Who referred you to Lutheran High? 

Upon request, Lutheran High School - Kansas City provides addresses or phone information for car pool placement, Booster Club functions, or other similar school related purposes.  Do you give permission for your demographic information to be distributed for these purposes? Yes/No 

I/We understand that photographs and/or video taken involving my/our child while a student at Lutheran High School - Kansas City may be used in publicity of Lutheran High School - Kansas City.  Yes/No   

I/We understand that at times my/our student may have access to the internet.  I/We also understand that it is impossible for Lutheran’s administrators, faculty and staff to monitor or restrict access to all controversial materials when students are given access to the internet.  I/We hereby release Lutheran High School - Kansas City, its operators, and any institutions with which it is affiliated from any and all claims and damages of any nature which may arise from my/our student’s use, or inability to use this access.  This policy will be in effect for the entire school year unless cancellation is submitted in writing. Yes/No  

I/We accept Lutheran High School - Kansas City’s practice to have my/our student tested (at parents’ expense) if suspicion of drug or alcohol use exists, in accord with our current policy regarding substance abuse.  Yes/No 

I/We submit this enrollment application, agreeing to the fees and policies of Lutheran High School - Kansas City for the 2019/2020 school year.  Admission may be withdrawn at any time if information provided in this application, other admission documents, or admission interviews is not complete and accurate. Yes/No  

I/We understand registration fees are non-refundable.  The school may hold records, including report cards and transcripts, if tuition or other school related bills are not fully paid. Yes/No  

I/We understand that should I/we remove my/our children from Lutheran High School - Kansas City anytime during the school year; all advance tuition paid to that point in time will become the property of Lutheran High School - Kansas City.    Yes/No  

Lutheran High School - Kansas City admits students of any race, religious preference, color, national, or ethnic origin to all rights, privileges, programs, and activities generally accorded, or made available to, students at the school.  It does not discriminate on origin in administration of its educational policies or other school administered programs.

Student acceptance at Lutheran High School - Kansas City will be based upon successful completion of the enrollment process, including availability of approved classes.


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