If you attended Galloway Academy Charter School during the previous school year, please complete the application below. If you did NOT attend Galloway Academy Charter School last year, please click here.

Download and print the Continuing Enrollment Application

or complete the online application below:

STUDENT INFORMATION

Student Name:

Date of Birth:

Age:

Gender:

Race:

Pictures of my child may be used for promotion of Galloway Academy:  Yes No

Current Grade:

School Attended During 2013-2014:

Received Free/Reduced Lunch:  Yes No

List Special Conditions if Applicable

Physical Disabilities:

Food Allergies:

PARENT INFORMATION

Parent Name:

Parent Address:

Parent City:

Parent State:

Parent Zip:

Parent Phone (Home):

Parent Phone (Work):

Parent Phone (Cell):

Parent Email:

Emergency Contact Information

Option #1

Name:

Phone:

Relation to Student:

Option #2

Name:

Phone:

Relation to Student:

Additional Information

Student Transportation (Please check one):  Bus Family Member Other

Family Pick-up Authority (Please print the names of those authorized to pick up your child.):

Name #1:

Name #2:

Name #3:

List others:

Parent/Guardian Signature:

Date:

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