PCA Enrollment Interest Form 2024-2025

PCA Enrollment Interest Form 2024-2025

Please only submit one form per household, and only for new students not currently enrolled. For the 2024-25 school year we will be serving transitional kindergarten through 12th grade students in portions of Riverside, Orange, San Diego, and Imperial Counties. *Para cambiar el idioma, use el botón en la esquina superior derecha.*
Parent/Guardian Information
Primary Parent/Guardian Name*

First NameLast Name
Relationship to Student
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.
Primary Parent Email Address*
PLEASE CAREFULLY ADD YOUR 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 / InglésSpanish / EspañolOther
Primary Phone*
Cell phone recommended.
Phone Type*

LandlineCell
Would you like to receive SMS Text Messages?*

YesNo
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

Zip Code
City*
Zip Code*
Do you already have a teacher you'd like to request?*
Teacher Name*
Last Name, First Name
Do you currently have a student enrolled at our school?*
How many NEW students do you intend to enroll?*
Do NOT count students currently enrolled for the 2023-2024 school year.
Student 1 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 School Year*
Student 2 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 School Year*
Student 3 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 School Year*
Student 4 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 School Year*
Student 5 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 School Year*
Student 6 Information

Please only enter information for NEW students.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in 2024-2025 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 Enrollment Interest Form 2024-2025

Parent/Guardian Information

Student 1 Information

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Student 6 Information

Terms and Conditions