Great Lakes Academy
46312 Woodward Ave. Pontiac, MI 48342 Phone: 248‑334‑6434 Fax: 248‑334‑6457
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Re-Enrollment Application

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Re-enrollment of current students is now open for the 2019-2020 school year. This form MUST be completed and returned to the Main Office. It is imperative that your reenrollment form is submitted during this timeframe so we may plan accordingly for the next school year and, more importantly, guarantee a place for your student.
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Student Information
Student Legal Name (as it appears on birth certificate)
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Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

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Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

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Required Input

Required Input

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Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Required Input

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Required Input

Required Input

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Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Required Input

Invalid Input

Required Input

Required Input

Invalid Input

Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

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Parent / Guardian Information
The effect of a sole custody award on authority of other parent (ORS 107.154). Unless otherwise ordered by the court, an order of sole custody to one parent shall not deprive the other parent of the following authority: To inspect and receive school records and to consult with school staff concerning the child's welfare and education, to the same extent as the custodial parent may inspect and receive such records and consult with such staff;

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if yes please provide documentation

Primary Parent / Guardian

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Phone number required

Phone number required

Phone number required

Must be a valid email address

Secondary Parent / Guardian

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Phone number required

Phone number required

Must be a valid email address

Additional Student Information
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(Please note, school based management plans must be completed by a physician and submitted yearly – if your child had a management plan for the 2018-2019 school year a new one MUST be submitted for 2019-2020).


Your child may be photographed or videotaped for inclusion in school publications and website, or in newspapers, magazines, articles, or letters relating to school activities

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NOTE: If your student will be picked up from school, you are required to fill out the Student Pickup/Release Form

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