Archdiocese of Miami Virtual Catholic School Enrollment Form - Summer 2017
Email any questions or concerns to Ms. Rebeca Bautista, principal, at principal@adomvirtual.com.

Thank you for your ongoing support of Catholic education.

Email address
Enrollment Form: Summer 2017
Earliest Start Date: June 19
Latest End Date: July 28
NO EXTENSIONS PAST JULY 28

Due dates for assignments will be determined by the start and end dates provided.

Is this your first time taking a course with ADOM-VCS?
STUDENT Last Name
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
STUDENT First Name
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Current Grade
Requested Start Date
MM
/
DD
/
YYYY
Requested End Date
MM
/
DD
/
YYYY
Student Type:
Name of current school:
If Home School, enter the name of the curriculum provider/group or district.
Your answer
E-mail Address - Student
Your answer
Date of Birth - Student
MM
/
DD
/
YYYY
Parent/Guardian Information
Enter "NA" if no information is available.
Parent/Guardian 1:
PARENT/GUARDIAN 1 Last Name
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 1 First Name
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 1 Email
Your answer
Parent/Guardian 1 Primary Contact Number
Your answer
Parent/Guardian 2:
PARENT/GUARDIAN 2 Last Name
Last Name will be used to create student account; username will be created, based on information included here.
Your answer
PARENT/GUARDIAN 2 First Name
First Name will be used to create student account; username will be created, based on information included here.
Your answer
Parent /Guardian 2 Email
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Parent/Guardian 2 Primary Contact Number
Enter 'N/A' if student only has one primary parent/guardian.
Your answer
Course Request
Courses - Use 'ENTER' after each course name
Example: Algebra I/Semester 1, English III/Semester 2, Economics, World History/Full Credit
Your answer
All ADOM-VCS Student-Parent Handbook rules apply. The Handbook can be found @ www.adomvirtual.com .
Required
A copy of your responses will be emailed to the address you provided.
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