School Enrollment Form

School Enrollment Form
Student Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemalePrefer Not to Say
Grade
Siblings at this School

YesNo
Siblings Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Language Spoken at Home
Ex: English
Living With
Parent / Guardian Information
Parent / Guardian Name

First NameLast Name
Relationship to Student
Ex: Mother
Gender

MaleFemalePrefer Not to Say
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Name

First NameLast Name
Relationship to Student
Ex: Mother
Gender

MaleFemalePrefer Not to Say
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Name

First NameLast Name
Home Phone
Please enter a valid phone number.
Business Phone
Please enter a valid phone number.
Relationship to Student
Name

First NameLast Name
Home Phone
Please enter a valid phone number.
Business Phone
Please enter a valid phone number.
Relationship to Student
Name

First NameLast Name
Relationship to Student
Home Phone
Please enter a valid phone number.
Business Phone
Please enter a valid phone number.
Allergies / Special Needs
Please list any allergies and or special needs
Educational Background
Previous School Attended
Ex: Kings College P.S.C
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last Grade Attended
Ex: 3rd Grade
First Entry to Elementary School

MonthDayYear
Date
Transfer Reason
As the parent/legal guardian, I give consent for my child to receive first aid from Adventure Avenue Academy staff, and, if necessary, to be transported for emergency care. I understand that I will be responsible for all charges not covered by insurance. I also agree to review and update this information whenever changes occur, and at least once a year.
Date

MonthDayYear
Date
Documentation Verified By

First NameLast Name
Signature

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Guardian Name

First NameLast Name
Signature

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Should be Empty:

School Enrollment Form

Student Information

Parent / Guardian Information

Emergency Contact Information

Allergies / Special Needs

Educational Background