| Charlton Heston Academy

Students must be 5 years of age by September 1, 2023, to enroll in kindergarten -waivers will allow students to enroll if 5 by December 1, 2023. Students must be 4 years of age by December 1, 2023, to enroll in Pre-K Pre-K Enrollment form: https://charltonhestonacademy.com/enrollment*

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*Mail correspondence will be sent to the address of Primary Parent/Guardian *School cancellation notice phone calls and all other mass communication calls will be made to the primary phone number for Primary Parent/Guardian *

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Student Name*

Last

First

Middle

Grade Entering In September 2023*

Pre-K/Childcare*

Yes

No

Student Residence Status:*

Other:

Are you a military family?*

Yes

No

What is the primary language spoken in your home:*

Primary Parent/Guardian Name*

Last

First

Middle

Address*

Street Address Line 2 City State Postal / Zip Code

Phone*

Email*

Secondary Parent/Guardian Name

Last

First

Middle

Address(1)

Street Address Line 2 City State Postal / Zip Code

Phone(1)

Email(1)

Emergency Contact #1*

Last

First

Relationship to student*

Emergency Contact Number(s): Primary*

Alternate #

Emergency Contact #2

Last

First

Relationship to student

Emergency Contact Number(s): Primary

Alternate #

The re-enrollment period is April 13, 2023 - April 28, 2023. Students currently enrolled in the Academy will be allowed to register during this time and thereafter. Open enrollment will be held on May 1, 2023 - May 12, 2023 for all families/students who are not currently enrolled at the Academy but with to enroll for next year (Fall 2023). Acceptance letters will be mailed to families by May 19, 2023. At that time the Academy will follow up with families to retrieve the following information: Copy of certified birth certificate Health Appraisal Certified copy of court-appointed custodial papers (if applicable) Up-to-date immunization record Copy of valid identification Copy of the student's last report card (if applicable) Please direct all enrollment questions to David Patterson, Superintendent at (989)-632-3390 or at dpatterson@charltonhestonacademy.com.*

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By typing my name below, I am confirming that the information given is true to the best of my knowledge. Failure to report accurate information may result in your child being withdrawn from the Academy. I agree to support the mission, vision, and polices of Charlton Heston Academy.*

Date of signature: *

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