Charlton Heston Academy New Enrollment 2018-2019

YOUR CHILD MUST BE 5 YEARS OF AGE BY SEPTEMBER 1ST, 2018 TO ENROLL IN KINDERGARTEN. WAIVERS WILL ALLOW STUDENTS TO ENROLL IF AGE 5 BY DECEMBER 1ST, 2018. YOUR CHILD MUST BE 4 YEARS OF AGE BY SEPTEMBER 1ST, 2018 TO ENROLL IN PRE-K*

Please Click If You Have Acknowledged This Statement

Grade Entering In September 2018

Please Type Name of Previous School *

Ethnic Background*

Other:

Student Name*

First

Middle

Last

Date of Birth*

day

/

month

/

year

Current Age*

Gender *

Male

Female

Student Address*

Street Address Line 2 City State Postal / Zip Code

Does your child receive school-based special services, i.e special education? If "yes," please check all that apply:

Other:

Family Information - Parent/Guardian Name*

First

Last

Middle

Address*

Street Address Line 2 City State Postal / Zip Code

Phone*

Email

Family Information - 2nd Parent/Guardian Name

First

Last

Middle

Address(1)

Street Address Line 2 City State Postal / Zip Code

Phone(1)

Email(1)

Emergency Contact's Name*

First

Last

Phone #*

Emergency Contact's Name #2

First

Last

Phone #2*

1. Siblings Name:

First

Last

2018-2019 Grade Level

Date of Birth:

day

/

month

/

year

2. Siblings Name:

First

Last

2018-2019 Grade Level

Date of Birth.

day

/

month

/

year

3. Siblings Name:

First

Last

2018-2019 Grade Level

Date of Birth;

day

/

month

/

year

4. Siblings Name:

First

Last

2018-2019 Grade Level

Date of Birth

day

/

month

/

year

Student Residence Status (please click the best answer): *

If transitional housing, please list reason.

Type your name(s) (first and last of parent(s)/guardian(s)) if you confirm that the information given is true to the best of your knowledge. You also agree failure to report information may result in your child being withdrawn from the Academy. To add, you agree to support the mission, vision, and policies of Charlton Heston Academy. *

Open enrollment will be held March 16th, 2018 - April 12th, 2018 for all families/students who are not currently enrolled at the Academy, but wish to enroll for the next year (Fall 2018). Acceptance letters will be mailed to families after this period. At that time the Academy will follow-up with families to retrieve the following information: - Copy of certified birth certificate - Health appraisal (Kindergarten & Grade 6) - 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 - All other applicable academic, medical, and/or other information - All questions can be directed to David Patterson, Superintendent at 989-632-3390 or at dpatterson@charltonhestonacademy.com. *

CLICK IF YOU HAVE ACKNOWLEDGED THIS STATEMENT