Magnolia Academy - CSEF  
                                                  (Church School Enrollment Form)
                                                                     Magnolia Family Ministry Adamsville, AL~ Fruitland Park, FL
                                           
*Church School Enrollment ~ To be Completed by PARENT or GUARDIAN
 
Student Name: _________________________________
 
Birth Date:_______________
 
Grade: ______
 
Address:____________________________________
 
City:____________________
 
 Zip:____________
 
 County:_______________________
 
 Phone #:_______________________________
 
Parent/Guardian:_______________________________
 
Signature of Parent/Guardian: x_____________________________                                                                                         

 
*COMPLETED BY ADMINISTRATOR
 
Church School of Enrollment:
 
Magnolia Academy              
3052 Pine Hill Drive   
Adamsville, Alabama
35005
 
Magnolia Academy
1505 Sp. Lk. Cv. Ln. #200
Fruitland Park, Florida
34731
 
Signature of Administrator: x______________________________________
 
Consent for Notfication Of Student Withdraw ~
 
* I hereby give prior consent to the Administrator or Magnolia Academy to notify the public school superintendent should the above named student cease attendence at said school.
 
Signature of Parent or Guardian: x_____________________________________________
Date:_______________
 
Original to Superintendent's Office
Copy to Magnolia Academy
Copy for Parents File