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Dixie Canyon Community Charter - Informational Sheet for 2018-2019
Note One - If your child is currently a student at Dixie Canyon, please DO NOT complete this form. This form should be completed ONLY for incoming students, including siblings of current students.
Note Two - Please complete this form ONE TIME ONLY.
Note Three - This form is ONLY for students who reside within the residential boundaries of Dixie Canyon. Non-residents must apply with a Lottery form. Lottery forms are available in the Main Office.
Child's Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
What grade will your child be entering in August, 2018? *
Parent/Guardian #1 Information
First Name of Parent/Guardian #1 *
Your answer
Last Name of Parent/Guardian #1 *
Your answer
Street Address *
Your answer
Suite/Apartment #
Your answer
City *
Your answer
Zip Code *
Your answer
Email address
Your answer
Day/Cell Phone *
Your answer
Evening Phone
Your answer
Driver's License Number *
Your answer
Parent/Guardian #2 Information - Complete if Applicable
First Name of Parent/Guardian #2
Your answer
Last Name of Parent/Guardian #2
Your answer
Street Address
Your answer
Suite/Apartment #
Your answer
City
Your answer
Zip Code
Your answer
Email address
Your answer
Day/Cell Phone
Your answer
Evening Phone
Your answer
Driver's License Number
Your answer
Completing this form does NOT guarantee enrollment.
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