School Registration
Leonardo Da Vinci International Academy
Additional documents for registration Bring this registration form and the following documentation to the school office • Original Certified Birth Certificate • Current Immunization Form •
Student Information
Name
*
First Name
Last Name
M.I.
Birth Date
*
-
Month
-
Day
Year
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Gender
*
Please Select
Male
Female
Email Address
*
Entry Year
*
Grade
*
Semester
Have you previously applied to or attended this school?
Yes
No
Current Residence Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
*
-
Area Code
Phone Number
Primary Residence Information (if different from above)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Residence Information (if different from above)
Name
First Name
Last Name
Relationship to the child
Please Select
Mother
Father
Grandparent
Guardian
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
Languages spoken at home
What are your child's greatest strengths?
What are your child's greatest challenges?
Do you have concerns with areas of your child's education or current school experience?
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Emergency Contact 1
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Emergency Contact 2
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Physician and Medical Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Preferred Hospital
*
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
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Previous School 1
School Name
City
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Date Started
-
Month
-
Day
Year
Date Picker Icon
Date Ended
-
Month
-
Day
Year
Date Picker Icon
Previous School 2
School Name
City
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Date Started
-
Month
-
Day
Year
Date Picker Icon
Date Ended
-
Month
-
Day
Year
Date Picker Icon
Previous School 3
School Name
City
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Date Started
-
Month
-
Day
Year
Date Picker Icon
Date Ended
-
Month
-
Day
Year
Date Picker Icon
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
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