Application for Admission

Application for Admission

Now enrolling!
General Information

Please Note: If enrolling multiple children, please list all students.
Student's Full Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
State & Country of Birth
Gender
Current Grade?
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Full Name

First NameMiddle NameLast NameSuffix
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Parent/Guardian Email Address
example@example.com
Parent/Guardian Full Name

First NameMiddle NameLast NameSuffix
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Parent/Guardian Email Address
example@example.com
Primary Language
Emergency Contact Name

PrefixFirst NameMiddle NameLast NameSuffix
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Emergency Contact Name

PrefixFirst NameMiddle NameLast NameSuffix
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Emergency Contact Name

PrefixFirst NameMiddle NameLast NameSuffix
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Is there a custody order present?
Who does the student live with?
Previous School Attended
Have your child attended school before?
Last School Attended
Reason for leaving?
Student Academic Performance
Current Grades (Please list all subjects i.e. Math, Reading, ELA, Science, Social Studies)
Please Upload Current/Last School Transcript (If Applicable)

*If you listed more than one student please upload All Student's School Transcripts*
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Please Upload Current/Last Student's Report Card (If Applicable)

*If you listed more than one student please upload All Student's Report Card*
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Have student repeated a Grade?
Have student ever been suspended or expelled? (If yes, please provide details)
Has student been evaluated or qualify for Exceptional Services (I.e. Special Education, Gifted & Talented, Speech Therapy etc.) (If yes, please provide details)
Does student have an Individual Education Plan (IEP/504 Plan) (If yes, please provide details)
Have student been diagnosed with any Psychological, Mental, Emotional, and/or Behavioral Diagnosis? (If yes, please provide details)
Programs & Services of Interest
Please select all services you are interested in for your child:
Transportation Services (Please Specify; Before or After School care) & Preferred Pick-Up/Drop-off Location
Residential addresses ONLY including zip code
Allergies & Medical Information
Describe all medical conditions or illnesses
Please list any allergies your child has (Food, environmental)
Does your child require medication or an emergency plan (e.g., EpiPen, inhaler)?(If yes, please explain)(how often)?
Name of Primary Physician/Healthcare Provider

First NameLast Name
In the event of a medical emergency, I authorize Ladies and Gents Private Academy to seek immediate medical attention for my child. I prefer my child be transported to:
Preferred Hospital (In Case of Emergency)
Preferred Hospital Address
Preferred Hospital Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is your child currently seeing a counselor or therapist? (If yes, please list service)
Media Consent & Release
I grant permission for Ladies and Gents Private Academy to use my child's photograph, video, or likeness for educational and promotional purposes, including school materials, social media, and the school website.
Parent Conduct & Social Media Policy
Ladies and Gents Private Academy values respectful and professional communication. We encourage parents/guardians to address any concerns directly with the school so they can be resolved appropriately. Parents/Guardians agree not to post, share, or publish false, defamatory, or harmful statements about the school, its staff, or its students on social media or any public platform. Failure to adhere to this policy may reult in appropriate action, including possible dismissal from the school and/or legal action when necessary.
Statement of Character & Integrity
Ladies and Gents Private Academy is committed to developing scholars who demonstrate integrity, respect, accountability, and excellence. We believe in nurturing the whole child academically, socially, and emotionally. By signing below, I acknowledge that I have reviewed the Statement of Character & Integrity and agree to support and uphold the values, expectations, and standards of Ladies and Gents Private Academy
Parent/Guardian First & Last Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Agreement
Please select all
Please review the Parent & Student Handbook in full before submitting your application.
Signature
Should be Empty:

Application for Admission

General Information

Previous School Attended

Programs & Services of Interest

Allergies & Medical Information

Media Consent & Release

Parent Conduct & Social Media Policy

Statement of Character & Integrity

Parent/Guardian Agreement