Are you enrolling for the 2021-2022 school year? *

Student's Legal Name (Last/First, Middle) *

Student's preferred name/nickname

Sex *

Current Grade (2020-2021) *

Student's physical address *

Student lives with (If not with parents, documentation must be provided) *

Student's Birthdate *

Student's Birth City *

Previous school name/ year *

Is student Latino/ Hispanic *

Ethnic Code (Check all that apply) *

Check all that apply *

Is your student under juvenile probation, suspended or expelled by current school? *

Primary guardian 1 (ex. mother) Full Legal Name *

Primary guardian 1 is *

Have parental rights been revoked? If yes, you must supply documentation *

Primary guardian 1's physical address (if different than student's)

Primary guardian 1's cell phone number *

Primary guardian 1's email address *

Check how you would like to receive notifications from Alpine Academy *

Primary guardian 2's full legal name *

Primary guardian 2's is *

Have parental rights been revoked? If yes, you must supply documentation *

Primary guardian 2's physical address if different from student's

Primary guardian 2's cell phone number *

Primary guardian 2's Email *

Check how you would like to receive notifications from Alpine Academy *

Stepparent living with student

Stepparent's phone number

Local Emergency Contact #1 include name, relationship to student, and cell phone # *

Local Emergency Contact #2 include name, relationship to student, and cell phone # *

Electives for the next year (please pick your top three choices)