Application Form
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Place of Birth
*
Sex
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level (School Year '25-'26)
Please Select
TK
K
1
2
3
4
5
6
7
8
9
10
11
12
School Last Attended
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's Information
Parent 1 Name
*
First Name
Last Name
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Parent 2 Name
First Name
Last Name
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.
Religious Affiliation
How did you hear about Pacific Oaks Academy?
Please Select
Family
Friend
Church
Online Search
Social Media
Word of Mouth
Advertisement
Event
Back
Next
Would you like to submit an application for another child?
Yes
No
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Place of Birth
Sex
Male
Female
Grade Level (School Year '25-'26)
Please Select
TK
K
1
2
3
4
5
6
7
8
9
10
11
12
School Last Attended
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Would you like to submit an application for another child?
Yes
No
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Place of Birth
Sex
Male
Female
Grade Level (School Year '25-'26)
Please Select
TK
K
1
2
3
4
5
6
7
8
9
10
11
12
School Last Attended
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Would you like to submit an application for another child?
Yes
No
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Place of Birth
Sex
Male
Female
Grade Level (School Year '25-'26)
Please Select
TK
K
1
2
3
4
5
6
7
8
9
10
11
12
School Last Attended
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: