Congratulations! Your application has been accepted for the 2017-2018 school year.

Completing this form is

the first step of the registration process. In order to reserve your students seat, it is imperative that you
complete and return this form by February 10, 2017 (scan, mail, bring in, or drop off in drop-box outside of
front office), or risk forfeiting your acceptance. Please make sure to complete one for EACH CHILD
ACCEPTED.

I accept admission for ______________________________________________ to Avant Garde Academy.

(Students Name)

Parent/Guardian Signature _________________________________________________ Date: ________________

Please review and complete the rest of this confirmation letter.

Student Information Questionnaire

Students Full Name: _______________________________________________________________________

Preferred Name: _____________________________________________________ Gender: __________

Ethnicity (Please circle): Hispanic Not Hispanic/Latino

Race (Please circle): American-Indian/Alaskan-Native Asian Black or African American White Native Hawaiian/Pacific

Age: ____ Date of Birth: ____________ Place of Birth: ___________________ Anticipated Grade Level: ____

Home Address: ___________________________________________________________________________

City: ______________________ State: _____ Zip: ___________ County of Residence: _________________

Home Number: _____________________________ Cell Phone: ____________________________________

Current School: ___________________________________________________________________________

Any siblings attending Avant Garde Academy for the 2017-2018 school year? Yes ___ No ___

Does your child receive a free/reduced lunch? Yes ___ No ___

Will your child need Before School Care _____ After School Care _____?

What language does your child speak most often? ___________________________

What language is most often spoken in your home? ___________________________

Do you live within 2 and 5 miles of the school and are you interested in Bus Transportation? Yes ___ No ___

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Has your child ever been suspended or expelled from present school or any other Florida Public School or

private school? Yes ___ No ___

If yes, please explain in detail and provide date(s). Please use additional paper if necessary.

________________________________________________________________________________________

________________________________________________________________________________________

Does he/she have a diagnosed disability? Yes ___ No ___ If yes, what is the disability?__________________

Does he/she have a current Individualized Education Plan? Yes ___ No ___

Does he/she have a current 504 Plan? Yes ____ No ____

If yes, please indicate the area of service receiving and when current IEP or 504 and re-evaluation are due?

________________________________________________________________________________________

Does he/she receive any related services? Yes ___ No ___

If yes, what related services (i.e. speech, OT, PT, etc.)?____________________________________________

Does your child receive Gifted services? Yes___ No ___

Does your child have any health concerns for which your child has seen a doctor in the last two years?

________________________________________________________________________________________

Does your child regularly take any medications?__________________________________________________

Does your child have any allergies? ___________________________________________________________

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My family commits to serve 10 volunteer hours. Avant Garde Academy recognizes that volunteering can look
very different for each family and we will provide you multiple ways to get involved to support our school!

I have filled out this application fully and certify that it is correct and accurate. I understand that if any
information given in this application is found to be false, I will lose my childs opportunity to be accepted at
Avant Garde Academy.

Parent(s)/Guardian(s) Signatures:

Parent/Guardian 1: _____________________________________________________________ Date: _______________

Parent/Guardian 2: _____________________________________________________________ Date: _______________

Return Completed Commitment Letter to:

Attention: Admissions
Avant Garde Academy
2025 McKinley St.
Hollywood FL 33020

admissions@agabroward.org
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