Legacy Charter School - Student Application Form

Fill out all the information below and submit the form. We will contact you after the form has been processed. Thank you.

* = Required field.

Scholar Name*:
Date of Birth*:
Gender*:	MaleFemale
Last Grade Completed*:
Current Grade*:
SCHOLAR CONTACT INFORMATION
Contact #1*:
Relationship #1*:
Address #1*:
City #1*:
State #1*:
Zip #1*:
Email #1*:
Home Phone #1*:
Work Phone #1:
Cell Phone #1:
Contact #2:
Relationship #2:
Address #2:
City #2:
State #2:
Zip #2:
Email #2:
Home Phone #2:
Work Phone #2:
Cell Phone #2:
Are any siblings currently attending Legacy Charter School?:	YesNo
List all siblings and their grade who are applying for 2010-2011 year enrollment:
PARENT / GUARDIAN STATEMENT
I certify that all of the answers given in this enrollment application are true.*:	Yes
Date (mm/dd/yy)*:

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