Phoenix Academy

Application For 2012 - 2013 School Year

Child's Information

First Name:
Middle Name:
Last Name:
Suffix:
Gender:
Date of Birth:
Child's Home Address:
Street:	Apt. #:
City:	State: Zip Code:
School child is currently attending:
Student School District:
For what grade level is this child applying?

Primary Parent/Guardian's Information

First Name:
Middle Name:
Last Name:
Suffix:
Primary Phone: - -
Secondary Phone: - -
Email:
Employer:
Occupation:
Work Phone: - -
Secondary Parent/Guardian's Home Address (if different from student's):
Street: Apt #:
City: State: Zip Code:

Secondary Parent/Guardian's Information

First Name:
Middle Name:
Last Name:
Primary Phone: - -
Secondary Phone: - -
Email:
Employer:
Occupation:
Work Phone: - -
Secondary Parent/Guardian's Home Address (if different from student's):
Street: Apt #:
City: State: Zip:

Volunteer Information

Phoenix Academy parents/guardians commit 4 hours of volunteerism per month as stated in the handbook.

If you have any parent training, hobbies, occupation, or other skills that would be valuable to our school please list:

In what areas will you be willing to volunteer? Please select your top three choices:

1st: Read Volunteer Details

2nd:

3rd:

Sibling Information

Sibling information is for our records. An individual application needs to be submitted for each potential student.

Are any of the following siblings also applying to attend Phoenix Academy this year?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

First Name: Last Name: Date of Birth (MM/DD/YY):

Is this child currently enrolled in Phoenix Academy?

Emergency Contacts

Please list two additional people who may be called in an emergency and who are authorized to take child from the school:

Name: Relationship:

Primary Phone: Secondary Phone: Other:

Name: Relationship:

Primary Phone: Secondary Phone: Other:

Agreement and Signature

If any information is incomplete, or not completely factual, this application may be voided and must be re-submitted. Falsifying or omitting information will cancel the application process and the student will have to reapply. To the best of my knowledge, the information given for this student is accurate and complete. By submitting this form I acknowledge by submission of this form I have given all information concerning this student, and that I have read and accept all terms and conditions set forth in the Student Handbook.
Choose Guardianship:
*If you are the Current Legal Guardian with court ordered papers, the documents must be submitted to Phoenix Academy prior to completion of the application process.

Name: Preferred Email:

Please submit your application only once.

or click to clear the application