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Cumberland Academy Enrollment Form

Cumberland Academy does not discriminate in the admissions process based on sex, national origin, ethnicity, religion, disability, academic ability, artistic ability, athletic ability, or the school district the child would otherwise attend under state law.

The school's decision to admit an applicant can be withdrawn if the school determines:

1. that the applicant provided false information on the admissions application;
2. that the school's later review of the applicant's education records indicates that the student should be placed in a grade level for which there are no spaces available; or
3. that the school's later review of disciplinary records indicates that the student is disqualified from admissions eligibility.

Parent/Guardian Information

Please fill out the form below to enter your students in the upcoming lottery

Parent First Name:	*
Parent Last Name:	*
Spouse (if applicable):
Street Address:	*
City:	*
State:	*
Zip Code:	*
Home Phone:	*	(###-###-####)
Other Phone:		(###-###-####)
Username:	*
Email Address:	*
Re-enter Email Address:
Accept Terms & Conditions:	*	(A check mark indicates agreement)

#	First Name*	Last Name*	Gender*	Birth Date*	School year*	Grade*
1			-- Select -- Female Male		-- Select -- 2010-2011	-- Select -- Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
+ Add a Student

Your child MUST be 5 years old on or before September 1st to be enrolled in Kindergarten.

Please only complete this form if you are enrolling a New Student.