C.O.R.E Academy Application Form

C.O.R.E Academy Application Form
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Home Address:

Street Address

Street Address Line 2

CityState

Zip Code
Previous School Information:

Street Address

Street Address Line 2

CityState

Zip Code
Grade student will be in for 2025-2026 school year*
Grade
Mother's/Guardian's Name*

First NameLast Name
Mother's/Guardian's Cell Phone Number:*
Format: (000) 000-0000.
Mother's/Guardian's E-mail*
example@example.com
Father's/Guardian's Name*

First NameLast Name
Father's/Guardian's Cell Phone Number:*
Format: (000) 000-0000.
Father's/Guardian's E-mail*
example@example.com
Name and address of Current Church*
Church
Name of Current Pastor*
Church
Is a parent in the military?*
Military Parent
If you answered "YES" to the question above, please help us to know the security/custody issues for the safety of your child.
Security/Custody Issues
Are there any security/custody issues with this child?*
Does the child have any special needs (ADD, Asperger’s, Dyslexia, etc.)*
If you answered "YES" to the question above, please list the special needs of the child. (ADD, Asperger’s, Dyslexia, etc.)
Special Needs
If you answered "YES" to the question above, please list your child's allergies.
Allergies
Does your child have any allergies? (peanuts, chocolate, etc.)*
Emergency Contact #1*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Emergency Contact #2*

First NameLast Name
In addition to those listed above (Guardian, Parents, & Emergency Contacts), please list the individuals who are also allowed to pick up your child from school.*
Allowed to pick up child.
Phone Number*
Format: (000) 000-0000.
Please list any individual who is NOT allowed to pick up your child from school.
NOT Allowed to pick up child.
Name

First NameLast Name
Name

First NameLast Name
Should be Empty: