Form

Student Information (enroll one student at a time)
*Student Name*
*Please mail a copy of the student's birth certificate, social security card and either most recent report card or transcript to: Edgewood Academy, P.O. Box 160, Elmore, AL 36025
Sex*

Male Female
Date to Enter
- Month - Day Year
at
/ Hour Minutes
Grade to Enter*
Birthday*
Last School Attended*
Family/Guardian Information
Home Address*
Home Phone*
Email Address*
Father's Name*
Occupation*
Work Number*
Mother's Name*
Occupation*
Work Number*
Complete this section only if student resides with someone other than parents:
Guardian's Name
Occupation
Home Number
Work Number
Is either parent or guardian a graduate of Edgewood Academy? If so…
Name
Graduating Year
Name
Graduating Year
Does this student have any siblings currently attending Edgewood? If so…
Name/Names and Grade
Medical/Emergency Information
In case of an emergency and if parents cannot be reached, contact:
Name*
Relation*
Phone*
Does the student have any known medical, emotional, or physical problems?*

Yes No
If Yes, explain fully:
Does the student take any type of medication?*

Yes No
If Yes, explain fully:
Has this student ever been in trouble with the civil authorities?*

Yes No
If Yes, explain fully:
I affirm that the above information is correct to the best of my knowledge. I fully understand that this is merely an application for enrollment and is subject to the approval or disapproval of the board of trustees. By pressing the "Submit" button below, I am agreeing to the previous statements.
Should be Empty:

Student Information (enroll one student at a time)

Family/Guardian Information

Medical/Emergency Information