Verity Acre Academy

Student Enrollment Form

School Year 2026-27

* Indicates required question

Enrollment Date

Date of Birth

Student Information

Students Legal Name

(First, Middle, Last)

Student Grade Level

Parent/ Authorized Guardian

Parent or Authorized Guardians to be able to drop and pick up or to be contacted in case of emergency.

Please provide at minimum 2 parent/ guardian information.

Parent or Authorized Guardians to be able to drop and pick up or to be contacted in case of emergency.

Please provide at minimum 2 parent/ guardian information.

Parent/ Guardian Information (1)

Parent/ Guardian Legal Name

(First, Middle, Last)

Parent/ Guardian (1) Relationship to Student

Parent/ Guardian Home Address (1)

(Where the student resides)

Street Name, City, State, Zip Code

Parent/ Guardian Contact Information (1)

(Best form of contact)

Cell Phone, Work Phone, Email Address

Parent/ Guardian Information (2)

Parent/ Guardian Legal Name

(First, Middle, Last)

Parent/ Guardian (2) Relationship to Student

Parent/ Guardian Home Address (2)

(Where the student resides)

Street Name, City, State, Zip Code

Parent/ Guardian Contact Information (2)

(Best form of contact)

Cell Phone, Work Phone, Email Address

Parent/ Guardian Information (3)

Parent/ Guardian Legal Name

(First, Middle, Last)

Parent/ Guardian (3) Relationship to Student

Parent/ Guardian Home Address (3)

(Where the student resides)

Street Name, City, State, Zip Code

Parent/ Guardian Contact Information (3)

(Best form of contact)

Cell Phone, Work Phone, Email Address

Enrollment Choices

Please provide the enrollment of your choice.

Include the specific day(s) of choice for 1 and 2 day enrollment.

Please provide the enrollment of your choice.

Include the specific day(s) of choice for 1 and 2 day enrollment.

Choose Student Enrollment

Full Enrollment (Monday, Tuesday, & Wednesday)

2-Day Enrollment (Monday & Tuesday)

2-Day Enrollment (Tuesday & Wednesday)

1-Day Enrollment (Monday)

1-Day Enrollment (Tuesday)

1-Day Enrollment (Wednesday)

Tuition Payment Type

Parent/ Guardian Certification

By filling out your name, today's date, and email address you certify that the below statement is true.

Include the specific day(s) of choice for 1 and 2 day enrollment.

By filling out your name, today's date, and email address you certify that the below statement is true.

Include the specific day(s) of choice for 1 and 2 day enrollment.

I certify that the information provided on this enrollment form is true, complete and accurate to the best of my knowledge. I understand that it is my responsibility to notify Verity Acre Academy of any changes to this information.

Print Name

Today's Date

Email Address

(863) 264-7644

info@verityacreacademy.com