Creekside Academy Application Form

School Application Form
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Place of Birth
Gender

MaleFemale
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level Last Completed
School Year
Grade Level Applying For
School Last Attended
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
Parent/Guardian's Name - Secondary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
Academic History
Academic Strengths
Academic Weaknesses
Does student have a current IEP?

yesno
Has student been retained at any time in grades K-6?

yesno
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Does the student have any medical conditions that you would like to declare?
Tuition
Pre-K $4,000/year

K-6th $4,500/year

Curriculum Fees

Pre-K and K $200

1st-6th $300

Tuition may be made in 10 monthly payments August-May. Semimonthly payments are an option as well.

Family plan

1st child: full price

2nd child or more: 20% off
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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School Application Form

Parent/Guardian's Information

Academic History

Health History

Tuition