2021-22 School-Year Programs - Enrollment Form
Please complete the form below to register your child for our 2021-22 Virtual Learning Academy and/or Afterschool Programs. Please complete an enrollment form for each child you wish to enroll.
Email *
Which program(s) do you wish to enroll your child in? *
Please select the program(s)
Required
Desired Start Date *
The Virtual Learning Academy and Afterschool Programs are scheduled to begin on Monday, August 2nd, the first day of the Bibb County School District academic year. Parents can choose to enroll at any point throughout the duration of the school year .
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Desired End Date (If Applicable)
Parents may choose to withdraw their child's enrollment at any time. The first semester of the 2021-22 school year ends on Friday, December 17th, 2021; the last day of the school will be Wednesday, May 25th, 2022.
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Child's Name *
Child's Birth Date *
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Age *
Name of Child's School *
Upcoming Grade *
Please select the grade your child will be entering at the start of the school year this fall.
Child's Gender *
Race/Ethnicity *
Please select one or more options.
Required
Child's Address *
Mother's or 1st Legal Guardian's Name *
Mother's or 1st Legal Guardian's Address
If different from student's.
Mother's or 1st Legal Guardian's Phone Number *
Mother's or First Legal Guardian's Place of Employment
Employer's Phone Number
Father's or 2nd Legal Guardian's Name
Father's or 2nd Legal Guardian's Address
If different from student's.
Father's or 2nd Legal Guardian's Phone Number
Father's or 2nd Legal Guardian's Place of Employment
Employer's Phone Number
Student's Living Arrangement *
Does your child have any special needs? *
If Yes, please explain.
Does your child have any allergies or medical needs? *
If Yes, please explain.
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