Three Rivers Academy

Three Rivers Academy 2010-2011 Returning Student Pre-Enrollment Form Pre-enrollment forms for students who wish to be considered for enrollment in 2010-2011. The appropriate application fee of $25.00 (non-refundable) must accompany this form. Payment must be in the form of check or cash. Family Information: Please print clearly and include all information requested.

Parents or Guardians’ Names______________________________

Home Telephone # _____________________________

Mailing Address ____________________________________

Zip______________

City _____________

State ____________

Mother’s Contact _______________________________

Father’s Contact # _____________________________________

Returning Student(s) Information: Only for students currently enrolled in 2009-2010.

1st Child Grade for 2010-2011 _____________________ _____________________

2nd Child Grade for 2010-2011 ________________________ _______________________

3rd Child Grade for 2010-2011 ________________________ _______________________


PLEASE READ CAREFULLY AND SIGN BELOW

I understand that any and all pre-enrollment/application fees I pay are completely non-refundable and non-transferable.

Parent or Guardian Name (please print) _____________________________________

Sign Here ____________________________________