Intent to Return
YOU MUST COMPLETE THIS FORM IN ORDER TO RE-ENROLL YOUR CHILD
FORM IS DUE BY February 17, 2022 TO HOLD YOUR CHILD SEAT.

Please note: the following information is not used for selection purposes.  Eastside Charter does not discriminate on the basis of race, creed, national origin, ethnicity, religion, sexual orientation, mental or physical disability, special needs, English language proficiency, athletic ability, or academic achievement.  
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Student Last Name *
Student First Name *
Student Middle Name
Grade Level for 2021-2022 *
Date of Birth *
MM
/
DD
/
YYYY
My child will be returning to EastSide Charter for the 2021-2022 School Year *
Child's Home Address (Street, City, State, Zip Code) *
Father/Guardian Last Name
Father/Guardian First Name
Father/Guardian  Home Number
Father/Guardian Work Number
Father/Guardian Cell Number
Father/Guardian Email
Mother/Guardian First Name
Mother/Guardian Last Name
Mother/Guardian Home Number
Mother/Guardian Work Number
Mother/Guardian Cell Number
Mother/Guardian Email
Emergency Contact First Name (someone not living with you) *
Emergency Contact Last Name *
Emergency Contact Phone Number *
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