Pre-Enrollment Form | Summit Charter School (Updated 2020)
**This is the updated version of our pre-enrollment form. Please complete this form even if you completed the prior version of this form. Thank you for your interest in and support of our school.**

The completion and submission of this pre-enrollment form confirms my intent to enroll my child(ren) in the Summit Charter School (SCS), However, I understand I am not obligated to enroll nor am I guaranteed enrollment by completing this document. I understand that the Summit Charter School has not yet been granted a charter to open. When the charter is granted for SCS, I understand that I will have to complete official enrollment documents in order for my child(ren) to be enrolled in SCS and to participate in the enrollment lottery if there are more potential students than seats available.  

If you would like to pre-enroll more than one child, please complete this form one time for EACH child, however, please do not fill out more than one form per child.

Please note that all fields are required. Please be sure to enter correct information in regards to dates of birth, entering grade, address, etc. since forms not completed in full or completed with errors may be considered incomplete and may not qualify for pre-enrollment.

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Email *
Parent/Guardian FULL NAME *
Parent/Guardian Phone Number *
Child's FIRST Name *
Child's LAST Name *
Child's Date of Birth (please verify YEAR as Google settings default to current year) *
Child's Grade Level AS OF September 1, 2021 (NEXT School Year) *
Home Street Address (No PO Boxes) *
City and Zip Code (all families must reside in the state of Pennsylvania) *
Public School District of RESIDENCE *
Current School Attending (indicate homeschool or include private, cyber/charter school information if not currently attending a traditional public school) *
By typing my full name below, I am providing my electronic signature and confirm my intent to enroll my child in the Summit Charter School (to be located in the Pocono Mountain School District) beginning in its first school year of operation under charter status, once charter approval is provided. *
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