Marriga Guidance Essay

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Required Items/Admissions Forms:                 Birth Certificate Social Security Card Photo I.D. Current Physical Insurance Card Medical Records School Records Shot Records Family Photo Assessment Summary Admissions Contract (notarized) Power of Attorney (notarized) Contact Form (with emergency numbers) A signed copy of Discipline Policies A signed copy of child abuse procedures Tuition Payment Please check off the list and make sure that all items are included in the package you send to us by Fed-Ex service, including this signed page! ABM Enrollment packet v12/15/12 Page 1 of 22 ABM Ministries Assessment Summary Date: Student Name: Date of Birth: Age: Home Phone: Church Affiliation: Pastor's Name: Current School Grade: Work Phone: Telephone Number: Medical History: Please list any medications the student is currently taking. Hobbies/Interests: Parent/Legal Guardian Name/s and Address/es: Print Name Print Name Address Address City, State City, State Zip Code Zip Code If student lives at a different address from above, list below. Address City/State Zip Code Relationship to Student: Mother/Father/Guardian/Other ABM Enrollment packet v12/15/12 Page 2 of 22 Who Has Legal Custody of the Student? Does the Student Live With Both Birth Parents? If Not Specify With Whom the Student Lives Questionnaire: Does the Student Appear to be: 1. Lonely, Quiet, Moody? 2. Depressed? YES NO YES NO (low energy, poor concentration, low motivation) 3. Suffering from low Self Esteem? 4. Very Negative About Everything? 5. Problems Sleeping? 6. Isolating Him/Herself? 7. Angry or Abusive to others? 8. Exhibiting Changed Eating Habits? 9. Argumentative and Deceitful? 10. Fighting at Home or School? 11. Doing Poorly in School? 12. Violating Curfew? 13. Shoplifting or Stealing? 14. Dropping out of school/church activites? 15. Using Alcohol or

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