Father/Guardian:
Name:  

Relationship to Child:

Address:

Contact Number 1:  ###-###-####

Contact Number 2:  ###-###-####

E-mail Address:

Mother/Guardian:
Name:  

Relationship to Child:

Address:

Contact Number 1:  ###-###-####

Contact Number 2:  ###-###-####

E-mail Address:   

Additional Information:

1. Is this applicant the child of a Charter Day School staff member? Yes No
    If yes, staff member's name:

2. Does this applicant have a sibling who is currently enrolled in Charter Day School that lives in the same household (includes half sibs, step-sibs, children     residing in family foster home)? Yes No
    If yes, current student's name and grade:   Grade: K 1 2 3 4 5 6 7 8

3. Does this applicant have a sibling who completed the highest grade level offered from Charter Day School and attended for at least four grade levels?     (includes half sibs, step-sibs, children residing in family foster home) Yes No
    If yes, alumni student's name and date of birth:

4. Has this applicant previously attended Charter Day School? Yes No      If yes, what was the reason for leaving and date of withdrawal?
   
    (MM/YYYY)            (Will not affect equal opportunity at lottery but may allow priority per G.S. 115C-238.29F)

5. Does this applicant have sibling(s) that live in the same household who are also applying to attend Charter Day School for the 2014-15 school year?
   Yes No
    (Note: Entering siblings will be placed together as a surname in the lowest grade level that is being applied. If the surname is selected in the case of a     lottery, all siblings shall be admitted to the extent that space is available.)

Verification Statement: I am the legal Guardian of the above student applicant and verify that all information provided is true and accurate to the best of my knowledge.