Crown AZ Academy Pre-Enrollment Form
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Email *
Mother's Name: (First, Middle, Last) *
Phone Number: *
Address: (Street, City, State, Zip) *
Email Address: *
Father's Name: (First, Middle, Last)
Phone: *
Address: (Street, City, State, Zip) *
Student NAME: (First, Middle, Last)
Gender: *
Date of Birth: *
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Entering Grade: *
Name & Address of Previous School Attended: *
Does this student have any medical conditions? *
If YES, please explain:
Does this student have an active IEP? *
Is this student participating in an English Language Learning Program (ELL)? *
Will Enrichment (before/aftercare) Services be needed? *
Has this student ever been expelled from a previous school? *
Please provide the following to Crown School as soon as possible:
Birth Certificate
Emergency Contact Information
Immunization Records
Proof of Residency
Parent/Guardian Signature: (By signing this you are stating that you have all rights and responsibilities to enroll above stated child) 
 *
Date: *
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Submit
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