Magnolia Company Academy

Magnolia Company Academy
2023-2024 Registration Form
Personal Information
Full Name
Sibling Name & Ages
Date of Birth
Gender

MaleFemale
Address
Label:
E Mail
example@example.com
Current School
Social Security Number
Grade 2023-2024

KindergartenFirstSecondThirdFourthFifthSixth
Parent Contact
Phone/Email
Parent Contact
Phone/Email
IEP/504 Plan

Yes
If yes, please attach a most recent copy of plan
Emergency Contact Details (other than parents)
Contact Name
Work Number
Relationship
Mobile Number
Office Use Only
Date Recieved

MonthDayYear
Date
Date Admitted

MonthDayYear
Date
Application Fee per family ($100) Staff Name
Application Fee per : family ($100)
Payment Plan
Staff Name
Staff Signature

Clear
The Mission Church 41347 I-55 Frontage Rd, Hammond, LA 70403 magnoliacommunityacademyagmail.com € ww.magnoliacommunityacademy.com
Tim and Brittany Hattier, Owners
Challenging the traditional. one- -size fits all model and practices of K-12 schooling by providing children with an unmatched education that sets the foundation for a lifetime of learning. critical thinking and community connection
Should be Empty: