Child’s Name:____________________________________________
Parents’
Name:___________________________________________
Address:________________________________________________
City: ____________________State:______Zip
code:____________
Home Phone:__________________
Mom Work Phone: _____________Cell
Phone:_________________
Dad Work Phone: _____________Cell
Phone:_________________
Child’s DOB: ________________
Grade ’07-’08: _______________
Please register my child in Evergreen
Academy. I have today submitted a $500.00 non-refundable registration fee.
I understand that the terms of this
Admission Form and all other forms and materials completed by me are subject to
the approval of the Directors of Evergreen Academy.
I, the parent, have read, understand and
agree to abide by the policies enclosed in the Parent Handbook.
__________________________________ _____________
Mother/Legal Guardian Date
__________________________________ _____________
Father/Legal Guardian Date
