Request edit access
Bethesda International Academy Enrollment Form
Bethesda admits students of any race, color, creed, sex, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students in this school
Email address *
Student's First Name: *
Your answer
Student's Last Name: *
Your answer
Name Commonly Used - if different than above
Your answer
Gender *
Required
Social Security Number: *
Your answer
Program Enrolling In: *
Required
Please check grade level: *
Extended Care Need:
Child's Date of Birth: *
MM
/
DD
/
YYYY
Place of Birth (City & State) *
Your answer
Age as of September 1st (current year): *
Your answer
Start Date: *
MM
/
DD
/
YYYY
Address: (Street, City, State, & Zip) *
Your answer
Phone Number: (Primary) *
Your answer
Phone Number (Secondary): *
Your answer
Father's Name and Full Address (Street, City & State) If not applicable, please use N/A. *
Your answer
Father's Occupation, Work Address, & Work Phone # If not applicable, please use N/A. *
Your answer
Mother's Name and Full Address (Street, City & State) If not applicable, please use N/A. *
Your answer
Mother's Occupation, Work Address, & Work Phone # If not applicable, please use N/A. *
Your answer
Marital Status of Parents: *
Who has legal custody? (Please provide copies of court orders or other legal documents to the school office). *
Neighborhood Public School *
Your answer
Did you previously receive Title I services *
Did your child participate in the Head Start Program *
Church Affiliation: *
Church Name: (Please indicate N/A if none) *
Your answer
Does your family attend church regularly? *
Is your child baptized? *
If you child is baptized, please list date and where:
Your answer
Cultural Background - Father *
Please specify father's country of origin: *
Your answer
Cultural Background - Mother *
Please specify mother's country of origin: *
Your answer
Does student have any siblings? Please list name, date of birth, and current school (if applicable): *
Your answer
Is there any other language, other than English, spoken at home?
If there is another language spoken in the home, please list below:
Your answer
Is your child adopted? *
If they are adopted, do they know?
Are there other adults living in the home? *
If yes, please describe:
Your answer
Does someone other than the parents have a significant role in child rearing? *
If yes, please describe:
Your answer
Is there anything else you feel we should know as we work with your child? (Please indicate N/A if no) *
Your answer
Have there been any recent changes within your family that could have an impact on your child's adjustments to school? (Please indicate N/A if no) *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy