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CAL Homeschool

2016-2017 S.Y.
SECTION 1: CHILD & FAMILY INFORMATION
Childs Name: Last:

First:

Birthdate (MM/DD/YYYY):

Middle:
Age:______

Sex:

Grade for the upcoming school year: _________________


Street Address:

The Child lives with mostly:


Mother & Father
Other: ________________
How well does my child speak English?

Mother

Very Well

Father

Well

Grandparent

Not Well

No English

Who will be the primary instructor? ____________________________________


Relationship to child:

Father

Mother

Legal Guardian

Other:____________

Previous Schools Attended:


1. Name: ______________________ City and or Branch: __________________ Grades: ___________
2. Name: ______________________ City and or Branch: __________________ Grades: ___________
3. Name: ______________________ City and or Branch: __________________ Grades: ___________
4. Name: ______________________ City and or Branch: __________________ Grades: ___________
5. Name: ______________________ City and or Branch: __________________ Grades: ___________

*Please write on a separate sheet of paper and attach it to this form if needed.
***NSO copy is needed prior to the start of the school year.***

Primary Contact Parent/Guardian:


Name:

Last:

First:

Middle:

CAL Homeschool
2016-2017 S.Y.
Relationship to child:

Father

Mother

Legal Guardian

Other:____________

Street Address:

1st Phone #: _________________

Landline

Cell

2nd Phone #: _________________

Landline

Cell

3rd Phone #: _________________

Landline

Cell

Facebook Name: _______________________________


Email: ________________________________________
Parent/Guardians Primary Home Language: ____________________________
Bilingual?

Yes
v
v

No
v
v

lf yes, what language(s)________________________

Secondary Contact Parent/Guardian:


Name:

Last:

Relationship to child:

First:
Father

Mother

Middle:

Legal Guardian

Other:____________

Street Address:

1st Phone #: _________________

Landline

Cell

2nd Phone #: _________________

Landline

Cell

3rd Phone #: _________________

Landline

Cell

Facebook Name: _______________________________


Email: ________________________________________

Emergency Contact: (other than the two people named above)


Name:

Last:

First:

Middle:

CAL Homeschool
2016-2017 S.Y.
Relationship to child:

Father

Mother

Legal Guardian

Other:____________

Street Address:

1st Phone #: _________________

Landline

Cell

2nd Phone #: _________________

Landline

Cell

3rd Phone #: _________________

Landline

Cell

SECTION 2: HEALTH & WELLNESS


Is your child on a special diet?

Yes
No If yes, please explain:
`
`
q to anyqof the following:
Please check if your child is allergic
v
v
cow's milk
eggs
v
peanuts
fish
v
`
v
`
`
q walnuts)
vwheat
q
qtree nuts (e.g.cashews or
soy
v
`
`v
v
v
vmedications: __________________________
q
qv
v
v
`
v
v
q
v
v
v
SECTION
3: DEVELOPMENTAL FACTORS
v

shellfish
`
q
other:
______________
`
v
q
v
v
v

Do you or someone else have concerns about your childs development in the following areas? (This
information will not affect your childs enrollment eligibility.)
Yes
No Holding & using small objects
Yes
No Walking, running, climbing
`
`
`
`
qYes qNo Early Learning skill
qYes qNo Social/Behavioral skills
`
`v
`v
v`
v
q
q
q
vYes vNo Speech and language development inv first/primary
vq
language
`v
`v
v
v
qvYes qvNo Any learning disabilities
v
v
v`
v`
vq the following if it applies:
Please
vq check
v
v
Special Needs
ADD
ADHD
Special Education
vGifted v
`
`
`
`
`
q
q
q
q
q
v
v
v
v
v
v
v
v
v
SECTION
4: SIGN AND DATE
APPLICATION
v

CAL Homeschool
2016-2017 S.Y.
My signature below verifies that the information provided to Cal Academy on this application is accurate
to the best of my knowledge.

Date _________ Parent/Guardian Name: ________________________ Signature: ________________


Date _________ Parent/Guardian Name: ________________________ Signature: ________________
Payment Contract
Please print and sign next to the option you have chosen
Option 1: Pay in Full (Cash)
Name:
Signature:
Additional Discount of 5,000 Php
Payment 1: 20,000 Php
Upon Enrollment
TOTAL: 20,000 Php
Option 2: Pay in 2 Payments
Additional Discount of 2,500 Php
Payment 1: 11,250 Php
Payment 2: 11,250 Php
TOTAL: 22,500 Php

Name:

Option 3: Pay in 3 Payments


Payment 1: 8,350 Php
Payment 2: 8,350 Php
Payment 3: 8,350 Php
TOTAL: 25,000 Php

Name:

Signature:
Upon Enrollment
November 1, 2016

Signature:
Upon Enrollment
September 1, 2016
November 1, 2016

CAL Homeschool
2016-2017 S.Y.