Enrollment Form

Welcome to CLK Home School Partnership Online Enrollment Form.

Items in bold are required.


Enrollment Date:
Student’s Full Name:  
Grade:  
Home Address:  
City:  
Zip:  
Gender:
County Residence:  
Township of Residence:  
Birth Date:  
Age:  
Birth City:  
Birth State:  
Name of Parent(s)/Legal Guardian(s):
 
Relationship:  
Phone:  
Cell:
Name of Parent(s)/Legal Guardian(s):
Relationship:
Phone:
Cell:
Parent/Guardian Email:  
Student Email:
Cell Phone:
Last School Attended:
Have you ever attended a public school?

If so, when and where?
Phone Number of School:
School Address:
City:
State:
Zip:
Do you have an IEP or 504 plan?

If Yes, please give a brief description of the IEP or Section 504 plan.  


Student Signature:  
Parent/Guardian Signature:
 
Date:
Word Verification: Type the characters you see in the image below:

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Thank you for your interest in the CLK Home School Partnership. Once you have submitted the form, a school official will contact you to complete the enrollment process.