Student Enrollment Form

Phoenix Academic & Early Learning Center Online Registration
Please COMPLETE one application for EACH student you wish to enroll at Phoenix.
Please Note: A non-refundable application fee of $25 for each new student must accompany this application.
All applications are subject to approval by the Phoenix Board of Directors.
All new families must attend a family interview before registering for classes. APPLICATION FEES are due prior to the family interview.
Student Application

Student Information
Student Information

Information about your child.
School Year:
Grade/Childcare Class Entering
Returning Student?

Yes No
For new students, who referred you to Phoenix?
Student's First Name
Student's Last Name
Student's Middle Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Home Phone
Please enter a valid phone number.
Student's Cell Phone
Please enter a valid phone number.
Student's Email (this will be used by staff and teachers to communicate with your student)
example@example.com
Student's Age
Student's Birth Date

Month Day Year
Date
Student's Sex/Gender

Female Male
Does your student have any special medical or learning needs? If so, please describe.

Siblings

Childcare History

School History

Has your student ever been dismissed or suspended from an educational facility?

No Yes
Explain
Has your student ever been denied admittance to an educational facility?

No Yes
Explain

Current Educational Plans
Classes your student is planning to take at PAC for the upcoming academic year. If you need to enroll more than four classes, please contact us.
Class 1
Class 2
Class 3
Class 4
Other classes your student will be attending and/or that you are planning to teach at home for the upcoming academic year. Please describe each class, it's name, subject, curriculum, and who the class is to be taught by. If more than four, please used the "Additional" text box at the end to describe the remaining classes.
Class 1
Class 2
Class 3
Class 4
Describe any additional classes, subject, curriculum, and teacher.

Finishing Up and Submitting Your Application
Describe your reasons and expectations for enrolling this student at PAC.
PAC is an educational center, not a school. We are structured to assist families who are committed to the concepts of Christian self-government and home schooling. This means that students are responsible for their own behavior and learning under the guidance of a parent or teacher. Please rate this student’s ability and willingness to function in such an environment using a one (1) to three (3) scale. One (1) is low, two (2) is average and three (3) is high.

Type a question

	Low	Average	High
Shows respect to and for authority
Listens to and obeys instructions
Completes assignments on time
Prompt
Works quietly and independently
Resists negative peer pressure
Willing to follow rules and regulations
Avoids excessive absences/tardiness

Is there any other information about this student or your family that would be helpful?
If you are done, go ahead and submit the form. If you need more time, you can save your form and come back to it later. You will receive an email with a link to your partially completed form.
Should be Empty:

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Phoenix Academic & Early Learning Center Online Registration