New Student
Returning student last attended session/year:
New family
If enrolling more than one student, please attach separate sheet with all necessary information.
Student's last name:
First name:
Middle name :
Age:
Date of birth:
Gender:
Male
Female
Social Security number:
c/o:
Address:
City:
State:
ZIP:
Name of school:
School_City
E-mail:
Grade entering
School programs involved in now?
Carroll Academy Teacher (if current student):
Previous experience (if new to the program):
Where did you hear about us?
PARENT INFORMATION
Mother's name
Father's name
Address (if different from above)
Home phone:
Parent/Guardian cell:
Mother business phone:
Father business phone:
Name of participant's physician:
Physician phone number:
SPECIAL NEEDS
Allergies:
Yes
No, If yes, please identify the type of allergy:
Treatment/care required:
Other? Please identify with specificity:
I have read and understand the policies.
I have completed and signed the release, waiver and consent form.
Check enclosed for $
Please charge $
Visa
MasterCard
American Express
Card number:
Expiration date:
Signature:
Date:
New lesson students: Please include a listing of all available times for lessons and a description of the student, detailing special needs and interests. Returning students: Communicate need for change of times directly with your teacher.
Session attending:
Fall
Spring
Summer
Title of course:
Location:
Class fee:
Additional information/comments:
Title of course:
Location:
Class fee:
Additional information/comments:
Title of course:
Location:
Class fee:
Additional information/comments:
Title of course:
Location:
Class fee:
Additional information/comments:
Please mail check, this application, a completed release, waiver, and consent form, as soon as possible to: Carroll University Academy, 100 N. East Ave., Waukesha, WI 53186
![[photo] Ganfield](../../images/current_students_leftside.jpg)
