Student First and Last Name
Student Birthday
Grade EnteringKINDERGARTEN1ST2ND3RD4TH5TH6TH
Student Social Security
Student Birth Place
Student Race (requestd by FLDOE)Hispanic/LatinoAmer. IndianAsianWhiteBlack/Afr.Amer.Hawaiin/Pacific Isl.
New Life Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic or other school administered programs
Student Address
Student Last School of Record
Guardian First and Last Name
Guardian Phone
Guardian Email
Emergency Conctact
Allergies or Medical Concerns
Does your child have any special needs or challenges?
Has your child been previously removed from any program public or private?YesNo
Custodial Parent/Guardianship and Records: New Life Academy assumes responsibility for making available only one (1) copy of any student’s records, such as report cards, progress reports, disciplinary reports, etc. In the case of dual or shared custody of a child, parents must decide at the time of registration who will receive the school copy of the reports. It is then up to that parent to provide copies of these reports to the other parent, when necessary. New Life Academy will provide the reports to the designated parent. If this is your families’ situation, OR if a parent has sole custody, official copies of the custody arrangement MUST be provided at time of enrollment.
Conduct and Maintaining Enrollment: I understand that the student on this form must abide by the rules and requirements set forth in the Parent Manual and the Code of Conduct. Failure to maintain passing grades or good behavior, or having chronic absences is among reasons to have enrollment revoked. (For full dismissal criteria consult the Parent / Student Handbook.) I attest that the information given on this application is true and accurate.
