The Odyssey Preparatory Academy Family of Schools

Navigating Knowledge ~ Creating Character

Goodyear Campus K-5

Grade student will enter

for the 2014-2015 school
year_________________

Scholar Name _______________________________________________________________________________________________________

Last
First
Middle
Gender_____________ Birth Date: _____________________________________________________________ Age_____________________
Month
day
year

Please complete the following IF any information has changed from what is currently on file.
Home
Address______________________________________________________________________________________________________________
City
State
Zip Code
Mailing Address ________________________________________________________________________________________________________
City
State
Zip Code
Home Phone______________________________ Mom work _________________________Mom cell___________________________________
Dad work ________________________ Dad cell_________________________ other cell _____________________________________________
Mom
email_________________________________________________________________________________________________________________
Dad
email_________________________________________________________________________________________________________________

Sibling Information
_____________________________________________________________________________________________
Name
Grade
School
_____________________________________________________________________________________________
Name
Grade
School

Emergency Contact Information

_____________________________________________________________________________________________
Name
Phone
Relation
_____________________________________________________________________________________________
Name
Phone
Relation
_____________________________________________________________________________________________
Students Physician
Phone

I INTEND TO ENROLL MY CHILD IN THE ODYSSEY PREPARATORY ACADEMY GOODYEAR K-5 FOR THE 2014-2015 SCHOOL YEAR.

______________________________________________________________________________________________
Parent/Guardian Signature
Date
PLEASE RETURN THIS FORM TO YOUR CHILDS TEACHER OR THE FRONT OFFICE NO LATER THAN
1/31/2014 TO ENSURE YOUR CHILDS SPOT AT ODYSSEY FOR THE 2014-2015 SCHOOL YEAR.