Life Learning Academy

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Student Registration Form

E-mailadres *

Today's Date *

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Parent Name *

Student Full Name *

Student DOB *

Home Address *

City, State and Zip *

Phone Number - - Text Y/N? *

Current grade level (for the school year you are registering for) *

School Year *

Where was your child previously registered?

*If registered as a home educated student through the county please let us know what county.

*If registered at a school, please let us know the name and location of the school.

*If this is your child's first year please let us know that, too.

What types of supports would you like to receive from the staff of Life Learning Academy? *

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