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Scholar Enrollment Application 2024-2025

We are thrilled that you have chosen Memphis College Prep as the school home for your child for the 2024-2025 academic year. Please complete the fields below. All fields marked with a red asterisk are required.

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Scholar Name: *
Address: *
ex. 123 Mane Street, Memphis, TN 38106
Gender *
Scholar's Date of Birth: *
MM
/
DD
/
YYYY
Scholar Age: *
Social Security Number:
ex. xxx-xx-xxxx
Parent/Guardian #1 Name: *
Parent/Guardian #1 Relationship *
Parent/Guardian #1 Phone Number:  *
ex. 901-555-5555
Parent/Guardian #1 Work Number :
ex. 901-555-5555
Parent/Guardian #1 Cell Number :
ex. 901-555-5555
Parent/Guardian #1 Email Address *
Parent/Guardian #2 Name:
Optional
Parent/Guardian #2 Relationship
Optional
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Parent/Guardian #2 Home Number :
ex. 901-555-5555   Optional
Parent/Guardian #2 Work Number :
ex. 901-555-5555   Optional
Parent/Guardian #2 Cell Number :
ex. 901-555-5555   Optional
How did you hear about MCP?
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What grade will the student be entering in the 2024-2025 school year?   *
Did your scholar attend Pre-K in 2023 - 2024?
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What school is your scholar transferring from? (Example: Shaw Elementary Memphis, Tennessee; leave field blank if they are beginning Kindergarten)
Does the student currently receive Special Education services under an Individualized Education Plan (IEP)? *
Does the student currently receive Special Education services under a 504 Plan? *
How will your scholar be picked up from school? *
Emergency Contact #1 Name *
Please list a person we can contact in case of an emergency if a parent/guardian cannot be reached. A contact person would be someone who lives in the neighborhood or is otherwise readily available. By listing this person you are also authorizing them to pick up your scholar from school in the event of an emergency.
Emergency Contact #1 Number *
Emergency Contact #1 Relationship *
Emergency Contact #2 Name *
Please list a person we can contact in case of an emergency if a parent/guardian cannot be reached. A contact person would be someone who lives in the neighborhood or is otherwise readily available. By listing this person you are also authorizing them to pick up your scholar from school in the event of an emergency.
Emergency Contact #2 Number *
Emergency Contact #2 Relationship *
Child Pickup Authorization #1 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #1 Number
Child Pickup Authorization #1 Relationship
Clear selection
Child Pickup Authorization #2 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #2 Number
Child Pickup Authorization #2 Relationship
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Child Pickup Authorization #3 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #3 Number
Child Pickup Authorization #3 Relationship
Clear selection
Child Pickup Authorization #4 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #4 Number
Child Pickup Authorization #4 Relationship
Clear selection
Child Pickup Authorization #5 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #5 Number
Child Pickup Authorization #5 Relationship
Clear selection
Child Pickup Authorization #6 Name
This individual has my permission to pick up my child from school. Any adult picking up a child must show their identification. Only list a name that is NOT a parent, guardian, or emergency contact listed above. Parents, guardians, and emergency contacts will be granted authorization to pick up the child.
Child Pickup Authorization #6 Number
Child Pickup Authorization #6 Relationship
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Special Remarks or Concerns
i.e. court orders, daycares, after school pickup alternatives
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