Apply for 2020-2021

Student Application for Admission - Heritage Academy - 2020-2021

Please carefully read “Admissions Process” below before completing.

Student Information
Student’s Legal - Last Name*
Last
First Name*
First
Middle Name*
Middle
Student’s Date of Birth*
Student’s Primary Residence*
Street Address City State ZIP Code
Student's Primary Phone*
Student's E-mail*
Grade Entering for the 2020-2021 School Year*
Is the student enrolled at Heritage Academy?*
- Yes
- No
Does the student have a sibling who is enrolled at Heritage Academy?*
- Yes
- No
Please list the sibling.*
Parent/Guardian Information
Parent/Guardian with Whom the Student Lives*
First Last
Parent/Guardian Primary E-mail*
Date of Birth*
Relationship to Student*
Father/Guardian Information
Father’s/Guardian’s Last Name
Last
Father’s/Guardian’s First Name
First
Father’s/Guardian’s Middle Name
Middle
Father’s/Guardian’s DOB
Father’s/Guardian’s Phone
Father’s/Guardian’s E‐mail
Father’s/Guardian’s Primary Residence (If Different From Student’s Address)
Street Address City State ZIP Code
Mother/Guardian Information
Mother’s/Guardian’s Last Name*
Last
Mother’s/Guardian’s First Name*
First
Mother’s/Guardian’s Middle Name*
Middle
Mother’s/Guardian’s DOB*
Mother’s/Guardian’s Phone*
Mother’s/Guardian’s E-mail*
Mother’s/Guardian’s Primary Residence (If Different From Student’s Address)
Street Address City State ZIP Code
Other Information
How did you hear about us?
If you chose "Other," please specify:
Digital Signature
Parent/Guardian Signature:*
“I certify that the information contained in this Form is true and correct.”
Date of Signature*
Form Information*
- I have read and understand and agree with all information on this form.

Student Application for Admission - Heritage Academy - 2020-2021

Student Information

Parent/Guardian Information

Father/Guardian Information

Mother/Guardian Information

Other Information

Digital Signature