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2021-22 CCA Registration Form
Congratulations! Your student has a spot reserved for them at CCA for the 2021-22 school year! We are so excited to have you join us. Please fill out the Registration Form to complete your enrollment.
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* Indicates required question
Email
*
Your email
Who referred you to Cherokee Charter Academy?
Your answer
Name of Person completing this form:
*
Your answer
Relation to the student:
*
Parent
Step-Parent
Grandparent
Guardian
Other:
Phone Number of Person completing this form:
*
Your answer
Student Legal First Name
*
Your answer
Student Middle Name
*
Your answer
Student Last Name
*
Your answer
Student Preferred Name
Your answer
Student Gender
*
Male
Female
Student Birthdate
*
MM
/
DD
/
YYYY
Student Grade for 2021-22 School Year
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Brade
Are there siblings already enrolled in CCA?
Yes
No
Clear selection
If yes, what is their name and grade?
Your answer
Is the student Hispanic or Latino?
*
Yes
No
Student's Race
*
Black / African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Student Mailing Address (MUST BE SC)
*
Your answer
Student Physical Address (MUST BE SC)
*
Your answer
Parent / Guardian Military Status
Full-Time National Guard - Deployed
Full-Time National Guard - Not Deployed
Full-Time Reserves - Deployed
Full-Time Reserves - Not Deployed
Active Duty - Deployed
Active Duty - Not Deployed
Neither Parent nor Guardian is serving in military service
Clear selection
If enrolling in Kindergarten, what type of 4K program is student currently in:
No 4K program
Head Start 4K
Public 4K
Private 4K
Other 4K
Clear selection
If enrolling in Kindergarten and they currently attend a 4K program, what school do they attend?
Your answer
Name of Student's Current School (2020-21 School Year)
*
Alma Elementary School
BD Lee Elementary School
Blacksburg Elementary School
Blacksburg Primary School
Corinth Elementary School
Draytonville Elementary School
Goucher Elementary School
Grassy Pond Elementary School
Limestone Central Elementary School
Luther Vaughan Elementary School
Mary Bramlett Elementary School
Northwest Elementary School
The Village School
N/A
Other
Required
If you chose "Other" for previous question, provide Address and Phone Number of Student's Current School (2020-21 School Year)
Your answer
Did student receive special services at current school?
*
IEP - Resource or Academic
IEP - Speech Only
504
Gifted / Talented
ESL
OT
My child received no special services
Other:
Required
Has your student ever been retained?
*
Yes
No
If yes to previous question, what grade level was he/she retained?
K
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Student's County of Residence
*
Cherokee County
Spartanburg County
Greenville County
York County
Other:
Please list any allergies the student has:
*
Your answer
Is your student currently taking any medication?
*
Yes
No
If "Yes", please list any medication your child is currently taking:
Your answer
How does your child plan to arrive/depart from school?
*
Bus (This is not a door-to-door service. The Bus Registration Form will be available June 15)
Car
Car/Bus Combination
YMCA (Held at CCA. You must sign up through Cherokee County YMCA)
Mother's First Name
Your answer
Mother's Last Name
Your answer
Mother's Cell Phone Number
Your answer
Mother's Email Address
Your answer
Mother's Place of Employment
Your answer
Mother's Work Phone Number
Your answer
Mother will be an Emergency Contact and is allowed to pick student up from school:
*
Yes
No
N/A
Step-Mother First Name
Your answer
Step-Mother Last Name
Your answer
Step-Mother Cell Phone Number
Your answer
Step-Mother E-Mail Address
Your answer
Step-Mother's Place of Employment
Your answer
Step-Mother's Work Phone Number
Your answer
Step-Mother will be an Emergency Contact and is allowed to pick student up from school:
*
Yes
No
N/A
Father's First Name
Your answer
Father's Last Name
Your answer
Father's Cell Phone Number
Your answer
Father's Email Address
Your answer
Father's Place of Employment
Your answer
Father's Work Phone Number
Your answer
Father will be an Emergency Contact and is allowed to pick student up from school:
*
Yes
No
N/A
Step-Father's First Name
Your answer
Step-Father's Last Name
Your answer
Step-Father's Cell Phone Number
Your answer
Step-Father's E-Mail Address
Your answer
Step-Father's Place of Employment
Your answer
Step-Father's Work Phone Number
Your answer
Step-Father will be an Emergency Contact and is allowed to pick student up from school:
*
Yes
No
N/A
Guardian First Name (If other than parent)
Your answer
Guardian Last Name (If other than parent)
Your answer
Guardian Cell Phone Number
Your answer
Guardian Email Address
Your answer
Guardian's Place of Employment
Your answer
Guardian's Work Phone Number
Your answer
Guardian will be an Emergency Contact and is allowed to pick student up from school:
*
Yes
No
N/A
Student lives with:
*
Mother Primarily
Father Primarily
Both Parents 100%
Both Parents 50% / 50%
Foster Parents
Guardian
Other:
Emergency Contact #1 (Not a parent) - First Name
Your answer
Emergency Contact #1 - Last Name
Your answer
Emergency Contact #1 - Relation
Grandparent
Other Relative
Friend
Clear selection
Emergency Contact #1 - Phone Number
Your answer
Emergency Contact #1 - This person may pick my student up from school
Yes
No
Clear selection
Emergency Contact #2 (Not a parent) - First Name
Your answer
Emergency Contact #2 - Last Name
Your answer
Emergency Contact #2 - Phone Number
Your answer
Emergency Contact #2 - Relation
Grandparent
Other Relative
Friend
Clear selection
Emergency Contact #2 - This person may pick my student up from school
Yes
No
Clear selection
Emergency Contact #3 (Not a parent) - First Name
Your answer
Emergency Contact #3 - Last Name
Your answer
Emergency Contact #3 - Phone Number
Your answer
Emergency Contact #3 - Relation
Grandparent
Other Relative
Friend
Clear selection
Emergency Contact #3 - This person may pick my student up from school
Yes
No
Clear selection
Emergency Contact #4 (Not a parent) - First Name
Your answer
Emergency Contact #4 - Last Name
Your answer
Emergency Contact #4 - Phone Number
Your answer
Emergency Contact #4 - Relation
Grandparent
Other Relation
Friend
Clear selection
Emergency Contact #4 - This person may pick my child up from school
Yes
No
Clear selection
Submit
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