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Crown School Pre-Enrollment Form
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* Indicates required question
Email
*
Your email
Mother's Name: (First, Middle, Last)
*
Your answer
Phone Number:
*
Your answer
Address: (Street, City, State, Zip)
*
Your answer
Email Address:
*
Your answer
Father's Name: (First, Middle, Last)
Your answer
Phone:
*
Your answer
Address: (Street, City, State, Zip)
*
Your answer
Student NAME: (First, Middle, Last)
Your answer
Gender:
*
Male
Female
Date of Birth:
*
MM
/
DD
/
YYYY
Entering Grade:
*
Choose
K
1st
2nd
3rd
4th
5th
6th
Name & Address of Previous School Attended:
*
Your answer
Does this student have any medical conditions?
*
Yes
No
If YES, please explain:
Your answer
Does this student have an active IEP?
*
Yes
No
Is this student participating in an English Language Learning Program (ELL)?
*
Yes
No
Will Enrichment (before/aftercare) Services be needed?
*
Yes
No
Maybe
Has this student ever been expelled from a previous school?
*
Yes
No
Please provide the following to Crown School as soon as possible:
Birth Certificate
Emergency Contact Information
Immunization Records
Proof of Residency
Parent/Guardian Signature: (By signing this you are stating that you have all rights and responsibilities to enroll above stated child)
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Submit
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