LIBERTY ACADEMY ENROLLMENT APPLICATION FORM

LIBERTY ACADEMY AT THE PRIORY

ENROLLMENT APPLICATION FORM
GENERAL INFORMATION
Date of Registration

Month Day Year
Date
Proposed Enrollment Date (Month/Year)
Proposed Department for Enrollment

Kindergarten Prep School Department High School Department Special Ed. Department
Student's Full Name (First, Middle, Last)
Student's Gender

Male Female
Student's Date of Birth

Month Day Year
Date
Student's Current Age
Student's Home Address
Student's Home Phone Number
Please enter a valid phone number.
Student's MOE E-mail Address (if already assigned one)
example@example.com
National Student Registration Systems (NSRS) Number (if already assigned one)
Mother's Name

First Name Last Name
Mother's Phone Number
Please enter a valid phone number.
Mother's Email Address
example@example.com
Mother's Occupation
Mother's Employer
Mother's Work Number
Please enter a valid phone number.
Father's Name

First Name Last Name
Father's Phone Number
Please enter a valid phone number.
Father's E-mail Address
example@example.com
Father's Occupation
Father's Employer
Father's Work Number
Please enter a valid phone number.
Guardian's Name

First Name Last Name
Guardian Home Address:
Guardian's Phone Number
Please enter a valid phone number.
Guardian's Email Address
example@example.com
Student lives with: (Please check all boxes that apply)

Both Parents Mother Father Step-mother Step-father Guardian Other
Other details:

Parents separated Parents divorced Mother deceased Father deceased
Who is financially responsible for the student:

Both Parents Mother only Father only Guardian Ministry of Education Other
ACADEMIC INFORMATION
Last school student attended
Reason for leaving
Expected Grade Entry Level
Please indicate the level of your child's academic work (Please select the option, A being the highest and E being the lowest)

A B C D E
Has the student ever been suspended, disqualified, expelled and refused admission for academic or disciplinary problems or similar action at any other school?

YES NO
If yes, please explain below:
Does your child have any learning or behavioural difficulties?

YES NO
If yes, please describe and be very specific
Has your child ever had/been referred for: (Please check the applicable box)

Speech therapy Counselling Psychological evaluation Repeated a Grade Psyco-educational Assessment Other
Does your child have a recent assessment (not exceeding 24 months)?

YES NO
PERSONAL DESCRIPTION
Briefly describe your child's character, personality, tastes and interests briefly:
CHURCH INFORMATION
Church Affiliation
Church Address
Pastor's Name

First Name Last Name
Church's Phone Number
Please enter a valid phone number.
How did you find out about Liberty Academy?

Family/Friend Online (Website/Social Media) Referred by a Therapist/Another School Via Church Affiliation Other
Please state the reason why you want your child to attend Liberty Academy:
SUPPORTING DOCUMENTS NEEDED

Please scan and send the following documents via e-mail to liberyatpriory@gmail.com to complete your application:

- Proof of Payment of $1500 Registration Fee

- Copy of Birth Certificate

- Copy of Immunization Card

- Two Passport Sized Photographs

- Copy of Last School Report

- Completed Transfer Form (if coming from another school)

- Copy of Last Assessment Report (if applicable/requested)

- Copy of NSRS Card (Required for all Grade 2 - 6 Applicants)

- Signed Parent Commitment & Statement of Faith Form

- Completed Medical Report Form (Due once accepted)

If unable to e-mail please drop off supporting documents to our main office at:

LIBERTY ACADEMY AT THE PRIORY

32 HOPE ROAD

KINGSTON 10

JAMAICA, W.I.

Tel. (876)960-5059/906-2244/ 630-0013/630-0016

N.B. The registration fee can be paid via bank transfer using the following banking information for Liberty Academy or via card/cash in the school's main office.

Account Name: Liberty Prep School
Account Type: Business Current or Checking Account No. 198013
Bank Name: The Bank of Nova Scotia (BNS)
Branch: New Kingston Branch
Branch No: 50575

Kindly send proof of payment to libertyatpriory@gmail.com if paid via bank transfer.

PLEASE NOTE THAT ALL APPLICATIONS ARE CONSIDERED INCOMPLETE AND WILL NOT BE PROCESSED UNTIL THE NECESSARY SUPPORTING DOCUMENTS ARE RECEIVED.

THANK YOU FOR CHOOSING LIBERTY ACADEMY!
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LIBERTY ACADEMY AT THE PRIORY

GENERAL INFORMATION

ACADEMIC INFORMATION

PERSONAL DESCRIPTION

CHURCH INFORMATION