GSA School Admission Form

School Admission Form

Please complete the form to begin enrollment for your child/ward. All questions with an * are mandatory.
Child's Name *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Place of Birth*
Religion*
Nationality*
Gender*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (fill up only if different from Residential Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of last school (If none, put "NONE")*
Parent 1 Name*

First NameLast Name
Parent 1 Phone Number*
Please enter a valid phone number.
Parent 1 Email *
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 Occupation
Work Telephone
Please enter a valid phone number.
Parent 2 Name

First NameLast Name
Parent 2 Phone Number
Please enter a valid phone number.
Parent 2 Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2 Occupation
example@example.com
Work Telephone
Please enter a valid phone number.
Guardian

First NameLast Name
Guardian's Phone Number
Please enter a valid phone number.
Guardian's Email
example@example.com
Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List at LEAST 3 emergency contacts (Name & phone number)*
Great Start Academy is committed to educate the child as a whole. The information you provide will help us to know the child petter. Please answer the following questions truthfully.
List the child's siblings if any. First name, last name and age
Is child living with you?*

yesnoOther
If you selected other, please state with whom
Does your child have special needs?*

yesnounsure
If you answered yes to the above, please explain
Does your child have allergies? If yes, please explain*
What are your child's fears?
In what way, if any, would you like to see Great Start academy influence your child's life?
Is there any additional information you would like to share?
Attach Scanned copy of most recent Report Card if any

Cancelof
Attach Scanned copy of Birth Certificate

Cancelof
Attach a scanned copy of Immunization

Cancelof
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

School Admission Form

Great Start Academy is committed to educate the child as a whole. The information you provide will help us to know the child petter. Please answer the following questions truthfully.