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

For:
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Due:
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For re-enrollment of current students for the 2018-2019 school year. This form MUST be completed and returned no later than February. It is imperative that your re-enrollment form is submitted during this timeframe so we may plan accordingly for the next school year and, more importantly, guarantees a place for your student.
* indicates required field
Student Information
Student Legal Name (as it appears on birth certificate)
Last Name*
Required Input

First Name*
Required Input

Middle Name
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Date of Birth*
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

Grade Level for 2018-2019*
Required Input

Gender*
Required Input

Add another child to this application?
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Last Name*
Required Input

First Name*
Required Input

Middle Name
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Date of Birth*
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

Grade Level for 2018-2019*
Required Input

Add another child to this application?
Invalid Input

Last Name*
Required Input

First Name*
Required Input

Middle Name
Invalid Input

Date of Birth*
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

Grade Level for 2018-2019*
Required Input

Add another child to this application?
Invalid Input

Last Name*
Required Input

First Name*
Required Input

Middle Name
Invalid Input

Date of Birth*
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

Grade Level for 2018-2019*
Required Input

Add another child to this application?
Invalid Input

Last Name*
Required Input

First Name*
Required Input

Middle Name
Invalid Input

Date of Birth*
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

Grade Level for 2018-2019*
Required Input

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;
Are there custody agreements, court restrictions or court orders regarding this student?*

Required Input

if yes please provide documentation

Primary Parent / Guardian
Does child reside with you?*

Required Input

Relationship to child*
Required Input

What is your relationship to child?*
Required Input

Last Name*
Required Input

First Name*
Required Input

Lives with child?*

Required Input

Has custody of child?*

Required Input

Address*
Required Input

Provide phone numbers*
Required Input

Home Phone*
Phone number required

Cell Phone*
Phone number required

Work Phone*
Phone number required

Email*
Must be a valid email address

Secondary Parent / Guardian
Is there Secondary Parent / Guardian information?*

Required Input

Does child reside with you?*

Required Input

Relationship to child*
Required Input

What is your relationship to child?*
Required Input

Last Name*
Required Input

First Name*
Required Input

Lives with child?*

Required Input

Has custody of child?*

Required Input

Address*
Required Input

Provide phone numbers*
Required Input

Home Phone
Phone number required

Cell Phone
Phone number required

Email*
Must be a valid email address

Additional Student Information
Please list any medical conditions / allergies*
Required Input

(Please note, school based management plans must be completed by a physician and submitted yearly – if your child had a management plan for the 2017-2018 school year a new one MUST be submitted for 2018-2019).


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
Photo Release*

Required Input


Please check one*

Required Input

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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