Livingston Classical Academy Enrollment Application Form
Welcome to Livingston Classical Academy!

Livingston Classical Academy in Whitmore Lake exists as a tuition-free public school to educate youth on our nation’s founding principles and empowers them, as free citizens, to pursue a virtuous life of happiness and excellence.

Please complete this form to enroll your child at Livingston Classical Academy for the Fall 2019 school year! We are located at 8877 Main St. Whitmore Lake, MI 48189.

If you have multiple children you would like to enroll, please fill out this form for each child.

Questions? Call 1 (734) 839-6307 or email LivingstonClassical@ChoiceSchools.com.

STUDENT INFORMATION
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
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/
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YYYY
Student's Gender
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Ethnicity/Race (Check all that apply) *
Required
EDUCATION INFORMATION
What school district do you currently reside in? *
Your answer
Last School Attended *
Your answer
What grade is your child enrolling in? *
School Address *
Your answer
SPECIAL EDUCATION INFORMATION
Did your student have an IEP, 504 Plan, or other special education services provided at a previous school? *
Does your student currently have an IEP? (IEP = Individualized Education Plan)
Does your student currently have a 504 plan?
HOME LANGUAGE
What language did the student learn when they first began to talk? *
Your answer
What is the primary language used at home? *
Your answer
Can the parent of the student read English? *
FAMILY INFORMATION
PARENT/GUARDIAN 1
First Name *
Your answer
Last Name *
Your answer
Relationship to student *
Your answer
Address *
Your answer
Email Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
PARENT/GUARDIAN 2
First Name *
Your answer
Last Name *
Your answer
Relationship to student *
Your answer
Address if different from parent/guardian 1
Your answer
Email Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
FAMILY/RESIDENCY INFORMATION
The student lives with their *
Your answer
Student living arrangement is: (check one) *
EMERGENCY CONTACT INFORMATION
Please provide contact information for individuals OTHER THAN THE STUDENT'S PARENTS/GUARDIANS who are authorized to pick the student up in the event of an emergency.
Emergency Contact 1 First Name *
Your answer
Emergency Contact 1 Last Name *
Your answer
Relationship to student *
Required
Primary Phone Number *
Your answer
LEGAL RESTRICTIONS ON THE RELEASE OF STUDENT
Are there any court documents that need to be in your student's file, specifically files related to who your student can/can't be released to? *
MEDICAL AUTHORIZATION
The procedures that will be followed in case of severe injury or life or death situations are as follows:
1. Parent/Guardian will be notified immediately
2. School personnel will summon 911 emergency response. If emergency transport is necessary, they will transport your child to the nearest hospital.
I give my permission to secure emergency medical and/or surgical treatment to my student if a medical emergency situation occurs. *
MEDICAL HISTORY
Does your student have medical needs that we need to know about? A document will be included in your welcome packet to submit more detailed information.
Your answer
PERMISSION TO RELEASE INFORMATION
There may be times during the school year when your student will receive awards and honors or may participate in an event. There may be a possibility that photographs are taken and articles are written by our newsletter staff or by local media sources. Therefore, each student is required to have a signed Permission to Release News Information on file at school.

I give permission to release items concerning school activities of my student on social media and to the press or other media sources. Additionally, I give permission for a photograph of my student participating in school activities to be used in promotional materials for the school and/or in local media coverage of school events, as well as the school's and management company's social media sites and websites.

Permission to have your student's photo used *
Permission to have your student's name used *
PERMISSION TO PARTICIPATE IN FIELD TRIPS OR SCHOOL ACTIVITIES ON SCHOOL PREMISE
I give my student permission to ride on a school bus or other mode of transportation, if necessary, to field trips. I understand that by signing this document I am giving permission for my student to ride with faculty and/or staff to field trips within a 25-mile radius of the school. Furthermore, I give permission to the adults on these trips to provide my student with emergency medical care as necessary. I understand that every effort will be made to contact me prior to providing care. Your student will not be allowed to participate on field trips if this permission slip is not signed. With the exception of Community Service courses, you will be notified of all off-campus field trips. For trips exceeding a 25-mile radius, additional written permission will be required.

Information concerning a specific field trip, such as date, time of departure and return, destination, cost, and means of transportation will be sent to the parent/guardian by the teacher prior to each field trip.

*
I also agree to allow school personnel to transport my student in case of an emergency *
How did you hear about us?
ADDITIONAL PAPERWORK
Proof of age, i.e. birth certificate, as well as, recent immunization record, and parent/guardian's form of identification will need to be copied to finalize enrollment at a later time.

Kindergarten students will also need a health appraisal and proof of vision screening. Grades 1-10 will need to provide the most recent report card.

You will receive a confirmation email with more information shortly after you complete this enrollment form. If you have additional questions at this time please email livingstonclassical@choiceschools.com.

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