Open Enrollment - Cottonwood (Site-Based)

Intake 2020-2021

Please note that this form is for the Cottonwood Site-Based High School (9-12) program ONLY. Please do not complete this form if you intend to enroll in Cottonwood Home Study (TK-12).
Parent/Guardian Information
Name *

First Name Last Name
e-mail *
Primary Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State

Zip Code
County of Residence *
We will verify this later via your Proof of Residence document.
Emergency Contact (If Parent/Guardian cannot be reached) *
Relationship to Student *
Emergency Phone *

Area Code Phone Number
Teacher Request *
Teacher Name *
Do you currently have a student enrolled in our school? *

Yes No
Student 1 Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Age
Grade in School 2020-21
Add Student 2?

Add Student 2
Student 2 Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Age *
Grade in School 2020-21
Add Student 3?

Add Student 3
Student 3 Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Age *
Grade in School 2020-21
Add Student 4?

Add Student 4
Student 4 Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Age *
Grade in School 2020-21
Add Student 5?

Add Student 5
Student 5 Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Age *
Grade in School 2020-21
Terms and Conditions
Today's Date

Month Day Year
Date
Checking 'I Agree' and signing below, you declare under penalty of perjury under the laws of California that you are the Parent or Guardian of the above student(s). By submitting an application, you agree to the storage of their personal details, in The Cottonwood School (TCS)'s administrative systems, whether on paper, computer or any other medium and to the usage of that information for TCS's purposes only. Ed Code § 47605(e)(4) Charter School Notice and Form
*

I Agree
Signature *
Should be Empty:

Intake 2020-2021

Parent/Guardian Information

Student 1 Information

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Terms and Conditions