top of page
J.BRIGGS
ACADEMY
Home
About
Apply & Enroll
Donate
More
Use tab to navigate through the menu items.
J.BRIGGS ACADEMY
ENROLLMENT APPLICATION
Student First Name
*
Student Last Name
*
Birthday
*
Month
Day
Year
Rising Grade Level (Upcoming Grade)
*
Gender
*
Male
Female
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Phone
*
Email
*
Address
*
Which program(s) are you interested in?
*
Pre-K Christian Academy
Summer Enrichment Program
After-School Program
Tutoring Services
Preferred schedule (For Summer Enrichment Program and/or After-School Program). Check all that apply.
Full day
Half day
Monday
Tuesday
Wednesday
Thursday
Friday
Please list any Medical & Emergency Details, including Allergies, Medications, & Dietary Restrictions.
Emergency Contact First Name
*
Emergency Contact Last Name
*
Emergency Contact Phone
*
Secondary Emergency Contact Phone
Please list any Academic/Developmental accommodations needed (Specific learning needs, required support, social/emotional development notes, challenges, etc.).
Submit
bottom of page
