Open Enrollment Interest Form

Blue Ridge Academy Interest Form

2022-2023
Thank you for considering Blue Ridge Academy as your school of choice for the 2022 - 2023 school year.

Our open enrollment window for the 2022 - 2023 school year is now closed. If you would like to join our waitlist, please complete this form and we will reach out to you if space becomes available.

For further information about our programs, please feel free to reach out to our local Family Liaisons. You may find our Family Liaisons by visiting the School Leadership page.

We will not be accepting multiple submissions as we are only taking one form per household. Please include all students you wish to enroll in this form.

Open Enrollment Interest Form

Blue Ridge Academy | 2022-2023
Thank you for your interest in enrolling in Blue Ridge Academy for the 2022 - 2023 school year! Please fill out the form below so that we may reach out to you regarding the next steps of the enrollment process.
Household Information
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Email Address *
example@example.com
Parent/Guardian Contact Number *
Please enter a valid phone number.
We will be using the email address and phone number indicated above to contact you throughout the enrollment process.
Relationship to Students *
Other Relationship *
Household Physical Address *

Street Address

Street Address Line 2

City State

Zip Code
County *
Due to teacher availability, we can only properly serve the following cities in Kern County:
- Rosamond
- Ansel
- Actis
- Mojave
- Reefer City
- Edwards AFB
Mailing Address same as Physical Address?

Yes
Household Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Mailing County *
Due to teacher availability, we can only properly serve the following cities in Kern County:
- Rosamond
- Ansel
- Actis
- Mojave
- Reefer City
- Edwards AFB
Student Information
We will not be accepting multiple submissions as we are only taking one form per household. Please include all students you wish to enroll.
Students
How many students do you want to enroll?
Student 1 Name *

First Name Last Name
Student 1 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 1 Grade Level *
Grade Level for the 2022-2023 school year.
Student 2 Name *

First Name Last Name
Student 2 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 2 Grade Level *
Grade Level for the 2022-2023 school year.
Student 3 Name *

First Name Last Name
Student 3 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 3 Grade Level *
Grade Level for the 2022-2023 school year.
Student 4 Name *

First Name Last Name
Student 4 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 4 Grade Level *
Grade Level for the 2022-2023 school year.
Student 5 Name *

First Name Last Name
Student 5 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 5 Grade Level *
Grade Level for the 2022-2023 school year.
Student 6 Name *

First Name Last Name
Student 6 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 6 Grade Level *
Grade Level for the 2022-2023 school year.
Student 7 Name *

First Name Last Name
Student 7 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 7 Grade Level *
Grade Level for the 2022-2023 school year.
Student 8 Name *

First Name Last Name
Student 8 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 8 Grade Level *
Grade Level for the 2022-2023 school year.
Student 9 Name *

First Name Last Name
Student 9 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 9 Grade Level *
Grade Level for the 2022-2023 school year.
Student 10 Name *

First Name Last Name
Student 10 Date of Birth *

Month Day Year
Students registering for Transitional Kindergarten must have a birthday on or before February 2, 2018.
Student 10 Grade Level *
Grade Level for the 2022-2023 school year.
Other Information
Requested Teacher
Teacher requests are not guaranteed, but will be fulfilled to the best of our ability.
Special Requests or Accommodations

Placement is not guaranteed and is determined by teacher availability. Requests might include: preferred language, learning philosophy, etc. 0/250
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Blue Ridge Academy Interest Form

Open Enrollment Interest Form

Household Information

Student Information

Other Information