Online Enrollment Form

Student Information

Student name

Date of birth MM/DD/YYYY

Age

Gender

Current School

Grade in Fall of 2020

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

If yes - 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 2020

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

If yes - Please describe

Name (Child 3)

Date of birth MM/DD/YYYY

Current School

Grade in Fall of 2020

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

If yes - please describe

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