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Lottery Registration for Admission 2018-2019

BCCLC Elementary  BCCLC Middle School 


2801 Hunters Loop Blackfoot, ID 83221  1350 Parkway Dr #30 Blackfoot, ID 83221 
(208)782-0744 Fax:(208)782-1330 (208)785-0381 Fax: (208)785-0349 
Email: ​jwells@bcclc.com Email: sround@bcclc.com  
Kindergarten-4th Grade   5th Grade-8th Grade 
Application must be submitted by ​4pm on Wednesday, March 14, 2018 ​to be included in the lottery for 2018/2019 admission. 
Once you have been enrolled at BCCLC you do not need to go through the lottery again. If you are not accepted, your child’s name 
will be added to the waiting list. You will need to fill out a new lottery form for the following school year.  
 

STUDENT INFORMATION 
 
Please Note:Students enrolling as kindergarteners must be 5 years old before September 1. 
#1 Student’s Full Legal Name :  
​ (Please Print) 

Birthdate:   Grade Applying For 2018/19:  


K 1 2 3 4 5 6 7 8  Sex: ​Male​ Female 

#2 Student’s Full Legal Name : 


​ (Please Print) 

Birthdate:  Grade Applying For 2018/19:  


K 1 2 3 4 5 6 7 8  Sex: Male Female 

#3 Student’s Full Legal Name : 


​ (Please Print) 

Birthdate:  Grade Applying For 2018/19:  


K 1 2 3 4 5 6 7 8  Sex: Male Female 

#4 Student’s Full Legal Name : 


​(Please Print) 

Birthdate:  Grade Applying For 2018/19:  


K 1 2 3 4 5 6 7 8  Sex: Male Female 

Parent/Guardian Information 
 

Name:  E-mail address:  

Home address:   Telephone Number(s): 


 

Name:  E-mail address: 

Home address:   Telephone Number(s):  


 
 

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