Bridgeton Public Charter School
Initial Registration Form
2022 - 2023 School Year
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Name of Student (Last Name, First Name, Middle Name) *
Address (Street, City, State, Zip): *
Grade Entering August 2022: *
Gender: *
Date of Birth *
*Kindergarten students must be October 1, 2016 or earlier.  
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Name of Person Registering *
Relationship to Student *
Home Phone #: *
Cell Phone #: *
Email Address:
Did you home school this student during 2020 - 2021 school year: *
Did this student attend private school during 2020 - 2021 school year: *
If applicable, name of private school:
If applicable, address of private school
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