2026-2027 Re-enrollment Application

Student Name*

Last

First

Middle

Grade Entering In September 2026*

Student Residence Status:*

Other:

Are you a military family?*

Yes

What is the primary language spoken in your home:*

Are you interested in online learning? (* Approval from the Superintendent is required)*

Yes

Are you interested in taking CTE classes or college classes*

Yes

I understand the signs and symptoms of a concussion

Yes

I consent to the disclosure of immunization information to the local health department:

Yes

I consent to Google's workplace policy:

Yes

*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 *

Please Click If You Have Acknowledged This Statement

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 #

Please return all enrollment applications to the main office at Charlton Heston Academy, fax them to 989-632-3393, or email them to office@charltonhestonacademy.com. The re-enrollment period is February 12th, 2026- February 28th, 2026. Students currently enrolled in the Academy will be allowed to register during this time and thereafter. Open enrollment will be held on March 1st, 2026 - March 31st, 2026, for all families/students who are not currently enrolled at the Academy but wish to enroll for next year (Fall 2026). Acceptance letters will be mailed to families by May 4, 2026. At that time, the Academy will follow up with families to retrieve the following information:
Copy of certified birth certificate
Health Appraisal
Updated Proof of Residency
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 Mark Church, Superintendent, at 989-632-3390 or mchurch@charltonhestonacademy *

Please Click If You Have Acknowledged This Statement

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: *

Authorized by Lake Superior State University

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