Valrico Academy

2013 - 2014 Student Online Application

Please select the grade that your child will be entering in August 2013  Please Choose One Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Student Information:

Student First Name       Student Middle Name        Student Last Name  

Student Social Security Number               Student School ID Number         Please Choose One  -- -- -- -- -- Male Female            

Students Date of Birth      mm/dd/yyyy                 Language spoken in the home: 

Parent/Legal Guardian Information:

Parent First Name       Parent Middle Name        Parent Last Name  

Parent Mailing Address: 

Parent City     Parent State     Parent Zip Code

Parent Home Phone     Parent Work Phone     Parent Cell Phone

Parent Email Address

Is a parent currently active in the Military?  -- No Yes

Sibling Information:

If a sibling of this student is currently attending the school please provide us with the Name of the student, grade of the student and date of birth of the student below:

Sibling Attending Name     Sibling Attending Grade Please Choose One Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5     Sibling Attending Date of Birth      mm/dd/yyyy

Will a sibling of this applicant be applying to this school for the 2013 - 2014 school year?  -- -- -- -- -- Yes No

If yes, please indicate the name and grade level for 2013-2014 below:

Please note:  A separate application must be completed for each student wishing to attend the school August 2013.

If yes, please indicate the name and grade level of the sibling/siblings

Sibling Name     Sibling Grade Please Choose One Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5     Sibling Date of Birth      mm/dd/yyyy

Sibling Name     Sibling Grade Please Choose One Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5     Sibling Date of Birth      mm/dd/yyyy

Sibling Name     Sibling Grade Please Choose One Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5     Sibling Date of Birth      mm/dd/yyyy

To the best of my knowledge, the above information is accurate and complete.  In the event of a change of address, phone number, name, etc.: I will notify the school.

Parent name completing the online application

Thank you for completing this online application for your child to attend the Valrico Academy at Celebration during the 2013 - 2014 school year.  You will receive an email confirmation after you click the Submit button below.