Harpswell Coastal Academy

Declaration of Intent to Enroll Form

for the 2017-18 School Year

Please complete this form to enter the lottery for a spot for the 2017-18 school year. Completion of this form does NOT commit your child to taking a spot if one is offered.

I, ________________________________________ (parent/guardian), intend to enroll my child, _________________________________________ (student name) at Harpswell Coastal Academy, beginning in the 2017-18 school year.

We currently reside in the city/town of ____________________ and the student is in ____ grade at ___________________________________________________(student's current school).

Student Date of Birth: ___/___/___

Parent/guardian signature: ________________________________ Date: ___/___/___

Parent phone: ___________________________

Parent email: ____________________________

Mail to: Harpswell Coastal Academy 9 Ash Point Road Harpswell, ME 04079

**** This must be received by Thursday, March 23rd, 2017 at 4pm

to enter our enrollment lottery for the 2017-18 school year. ****