PCA Open Enrollment 2021-2022

PCA Open Enrollment 2021-2022

Please only submit one form per household, and only for new students not currently enrolled. *Para cambiar el idioma, use el botón en la esquina superior derecha.
Parent/Guardian Information
Primary Parent/Guardian Name *

First Name Last Name
Primary Parent Email Address *
This will be the primary means of contact if you are offered a spot. Please add an email that is closely monitored and add Pacific Coast Academy to your contacts.
Preferred Language of Correspondence / Idioma de correspondencia preferido *

English / Inglés Spanish / Español
Primary Phone *
Cell phone recommended.
Phone Type *

Landline Cell
County of Residence *
We will verify this with your Proof of Residence document. You must reside in one of the available counties to enroll.
Address *

Street Address (No PO Boxes allowed, physical addresses only)

Street Address Line 2

City State / Province

Postal / Zip Code
Alternate Contact Name *

First Name Last Name
Relationship to Student *
We will only reach out if we cannot make contact through the primary parent/guardian email and phone.
Alternate Contact Phone *
Cell phone recommended.
Phone Type *

Landline Cell
Do you already have a teacher you'd like to request? *
Teacher Name *

First Name Last Name
Do you already have a student enrolled? *
District ID of Enrolled Student *
How many NEW students do you intend to enroll? *
Do NOT count students currently enrolled for the 2020-2021 school year.
Student 1 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 2 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 3 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 4 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 5 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 6 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 7 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Student 8 Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade in 2021-2022 School Year *
Terms and Conditions

By checking 'I Consent' and signing below, you declare under penalty of perjury under the laws of California that you are the Parent or Guardian of the above student(s). By submitting an application, you agree to the storage of their personal details, in Pacific Coast Academy's administrative systems, whether on paper, computer or any other medium and to the usage of that information for Pacific Coast Academy's purposes only. Ed Code § 47605(e)(4) Charter School Notice and Form. In addition, you acknowledge that this form does not guarantee your student(s) enrollment at Pacific Coast Academy.
Consent to Terms and Conditions *

I Consent
Signature *

Clear
Should be Empty:

PCA Open Enrollment 2021-2022

Parent/Guardian Information

Student 1 Information

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Student 6 Information

Student 7 Information

Student 8 Information

Terms and Conditions