PAE Enrollment Application

196 Cesar E. Chavez Ave. Pontiac, Michigan 48343
Phone: 248-745-9420

If you are re-enrolling, please use the following link,

When enrolling for Kindergarten, please submit the following information to Mrs. Mendoza @

* A copy of the applicant’s birth certificate (need to see original).
* A complete health report (Kindergarten applicants only) completed by a medical personnel. Including vision
   (MUST HAVE) and hearing screening.
* An updated immunization record (Must have the most recent immunization).

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Email *
Building Level *
Today’s Date *
Has your child ever attended any school before? *
Student Name (Last, First, Middle Initial) *
Other Last Name Student may use
Entering Grade *
Gender *
Was the student born outside of the US? *
If born outside the US, when did the student enter US schools?
Is your child’s native tongue a language other than English?
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If yes, what is that language?
Is the primary language used in your child’s home or environment a language other other than English?
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If yes, What is the language?
Is your child Hispanic/Latino? (Choose one)
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Ethnicity *
Educational Services:
Birth date *
Birth Place *
Phone Number *
Address *
Adult Parent/Guardian Name *
Home/Cell Phone Number *
Work Phone Number
E-mail address
Adult Parent/Guardian Name
Home/Cell Phone Number
Work Phone Number
E-mail address
How did you hear about our school?
Emergency Medical Conditions/Problems: check ALL that apply
Will your child be taking medication during school hours?
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Other children who reside in the home (Name, Birth date, Grade, Attending P.A.E.)
Does your child attend a daycare center or go to a sitter after school?
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Do you affirm, that as the parent/legal guardian, all information provided above is true and accurate, and that my child and I reside at the listed address. *
A copy of your responses will be emailed to the address you provided.
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