1350 N St Helen Rd
St. Helen, MI
Main Office
(989)-632-3390
7:30am – 5:30pm
Monday-Friday
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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
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Kindergarten
Pre-K/Childcare
Please Type Name of Previous School
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Ethnic Background
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African American
American Indian
Hispanic
Caucasian
Latino
Other
Other:
Student Name
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First
Middle
Last
Date of Birth
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Current Age
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Gender
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Male
Female
Student Address
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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:
Speech Therapy
Occupational Therapy
Physical Therapy
Social Work
Academic Support
Other:
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
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Kindergarten
Pre-K/Daycare
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2. Siblings Name:
First
Last
2018-2019 Grade Level
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Kindergarten
Pre-K/Daycare
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3. Siblings Name:
First
Last
2018-2019 Grade Level
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11th
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8th
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5th
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3rd
2nd
1st
Kindergarten
Pre-K/Daycare
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4. Siblings Name:
First
Last
2018-2019 Grade Level
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st
Kindergarten
Pre-K/Daycare
Date of Birth
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Student Residence Status (please click the best answer):
*
Single family living in a house or dwelling
More than one family living in the house or dwelling
Lives with friends or relatives (other than parents/guardians)
Foster Care
Hotel/Motel
Shelter
Transitional housing
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.
*
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