Level's Business and Technology Academy Enrollment Application

Level's Business and Technology Academy Enrollment Application
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Child's Previous School Name
School Name
Child's Teacher's Name

PrefixFirst NameLast Name
Child's Current Grade for 24-25 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
Family's Church
Church
Are there any security/custody issues with this child?*
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
Does the child have any special needs (Speech, Occupational, ADHD, 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
Does your child have any allergies? (peanuts, chocolate, etc.)*
If you answered "YES" to the question above, please list your child's allergies.
Allergies
Emergency Contact #1*

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

First NameLast Name
Phone Number
Format: (000) 000-0000.
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.
Please list any individual who is NOT allowed to pick up your child from school.
NOT Allowed to pick up child.
My child will get home by:*

Parent pick up at 2:30pm.Afterschool Program (Paid options)
I release Level's Academy to take pictures and video of my child, which will be used for media and marketing purposes.*

yesno
What are your educational goals for your child?*
Enter step up for students Award ID#*
If an emergency takes place I release Level's Academy to contact the nearest hospital on my child's behalf.*

I agree
I understand Level's Business and Technology Academy is a Faith-Based School. I understand by enrolling my child into Level's Academy they will participate in prayer and reading the Bible weekly.*

I understand
I understand Level's Academy is a Florida Approved Private School and the tuition for this school can be covered with the Step Up for Students Scholarship. I understand once enrolled I am responsible for providing Level's Academy with all correspondences needed from Step up for Students for my child.*

I understand and I agree
Please up load physical and shot records ( For Kindergarten Only)

Cancelof
File Upload for Previous Grade and Test Scores

Cancelof
Should be Empty: