2016-2017 Grades K - 8 Initial Application Gulf Coast Charter Academy South 215 Airport-Pulling Ro...

2021-22 Initial Application

Parrish Charter Academy

KG - 5th Grade

(941) 545-6380

Email: Rfowler@pcaedu.org

Web: www.pcaedu.org

Student Information

Please submit only one application per student.

Student Last Name: *

Student First Name: *

Student Middle Name:

Grade for 2021-22 School Year *

Student Date of Birth: *

Student Gender: *

Male Female

Currently enrolled PCA sibling? *

Yes No

Current Sibling Name:

Contact Information:

Residing Address

Student Street Address *

City *

State *

Zip Code *

Mother/Guardian

Mother/Guardian Last Name: *

Mother/Guardian First Name: *

Mother/Guardian Email: *

Mother/Guardian Home Phone: *

Mother/Guardian Cell Phone: *

Father/Guardian:

Father/Guardian Last Name: *

Father/Guardian First Name: *

Father/Guardian Email: *

Father/Guarian Home Phone: *

Father/Guardian Cell Phone: *

Last School Attended:

Please select last school attended: *

If other, list name, city and state of last school

How did you hear about PCA? *

Online Facebook Advertisement Event Family/Friend Other

Please describe how you heard about PCA or the family name of who referred you: *

I certify that the above enrollment information is true and accurate to the best of my knowledge.

Printed Name of Parent/Guardian *

Relationship: *

Date: *

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