Admissions

Liberty Academy Charter School
211 Sherman Avenue
Jersey City, New Jersey 07307
201-217-6771 · Fax: 201-217-6772

PLEASE CHECK THE AVAILABILITY OF CLASSROOM SPACE BEFORE SUBMITTING THESE FORMS:

ENROLLMENT CHECKLIST

The following forms must be completed and submitted in order to comply with state law.

  Application
  New Pupil Registration
  Record Release Form
  Transfer form (yellow slip from public school)
  Transfer form (from Charter School)
  Medical History Form

The following documents must be submitted:

  Birth Certificate
  Immunization Record
  Proof of Residency (PSE&G OR Telephone Bills )
  Valid/Most Recent Report Card
  IEP (for special education students only)

 Parent’s Name: Print__________________________
 Are there custody issues? ____Yes____No
 (If yes, you must provide copy of court order)
 Address:_____________________________________
 Home Phone:____________________
 Cell Phone:
 Work Phone_____________________
 For office use only:
 Documents received by: _________________________ Date _________

STUDENT REGISTRATION FORM

 INFORMATION ABOUT YOUR CHILD:
 1. Student’s Last Name_______________________________
 2. Student’s First Name_______________________________
 3. Middle Name_____________________________
 4. Birth Date_______________________________ 
 5. Sex _________male__________female 
 6. Ethnic Origin:  White  Black  Hispanic   Native American/Alaskan  Asian/Pacific Islander
 7. Student: current grade________ grade attending in 2007-2008______
 8. US Citizen________yes_________no
 9. Previous School and Location____________________________
  ________________________________________________________

 INFORMATION ABOUT THE PARENT/GUARDIAN:
 Check one:  Mother  Father  Guardian  (must have legal proof attached to packet.)
 Name of parent/guardian Print_____________________________
 Address______________________________________________
 City & State__________________________________
 Zip _______________
 Home phone number__________________________
 Cell Phone#________________________________
 Business_______________________________________________________
 Signature of parent/ guardian__________________________ Date_______
 Signature of Principal__________________________ Date______________