Online Enrollment Form

Student Information

Student name

Date of birth MM/DD/YYYY

Age

Gender

Current School

Grade in Fall of 2019

Address

City

State

ZIP

Special Services Received (required) None Gifted & Talented Occupational Therapy Physical Therapy Speech Therapy Resource Room Other

If other - Please describe

Does your child have an IEP? (required) Yes No

Has your child ever received disciplinary action resulting in missing school? (required) Yes No

Please describe

Parent or Guardian Information

Guardian name

Home Phone

Cell Phone

Address, if different than student

City

State

ZIP

E-mail Address

Relationship to child:

Highest Level of Education

Please enter names of other children interested in attending Bay City Academy

Name (Child 2)

Date of birth MM/DD/YYYY

Current School

Grade in Fall of 2018

Name (Child 3)

Date of birth MM/DD/YYYY

Current School

Grade in Fall of 2018

How did you hear about us? (required) Current BCA Family Facebook Twitter Instagram Other