Pre-Enrollment Interest
Liberty Leadership Academy
Student's First Name
*
Student's Last Name
*
Parent Guardian Email
*
example@example.com
Primary Contact Phone Number
*
-
Area Code
Phone Number
Address City
*
Cottonwood
Camp Verde
Clarkdale
Cornville
Lake Montezuma
Jerome
Rimrock
Sedona
Other - list below
other city
Gender
Male
Female
2020-2021 Student Grade Level
*
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
2019-2020 School attendance
What school does your child attend this year?
Why are you leaving your current school?
School hours desire
8:00-3:00
8:30-3:30
Are you interested in before or after school supervision?
Yes, before and after
Yes, before only
Yes, after only
Yes, only if free
No, not interested
Are you interested in Friday activities & supervision?
Full day weekly
1/2 day weekly
Occasionally
Rarely / Never
Only if participation is free
Submit
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