Genesis Academy Re-Registration Form 2021-2022

Student Cell Phone

Name

First NameMiddle NameLast Name

Mailling Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student lives with (check all that apply)

Parent/Guardian Name (Last/First)

Relationship

Home Phone

Please enter a valid phone number.

Work Phone

Cell

Please enter a valid phone number.

E mail

example@example.com

Has permission to (check all that apply)

Pick up studentReceive mailingsContact school for student infoHave contact with Student

Active Military

NoYes

Parent/Guardian name (Last/First)

Relationship

Home Phone

Please enter a valid phone number.

Work Phone

Please enter a valid phone number.

Cell

Please enter a valid phone number.

E mail

example@example.com

Has permission to (check all that apply)

Pick up studentReceive mailingsContact school for student infoHave contact with student

Active Military

NoYes

Emergency Contacts Name

Relationship

Home Phone Number

Please enter a valid phone number.

Work

Please enter a valid phone number.

Cell

Please enter a valid phone number.

Is this person authorized to release the student?

YesNo

Emergency Contacts Name

Relationship

Home Phone Number

Please enter a valid phone number.

Work Phone Number

Please enter a valid phone number.

Cell Phone Number

Please enter a valid phone number.

Is this person authorized to release the student?

YesNo

PARENT SIGNATURE FOR RE-ENROLLMENT

I, blanks the parent of blank would like my child to be enrolled at Genesis Academy for the 2021-2022 school year.

Parent/Guardian Signature

Date

Arizona Residency Documentation Form

Student

Parent/Legal Guardian

As the Parent/Legal Guardian of the Student, I attest that I am a resident of the State of Arizona and submit in support of this attestation a copy of the following document that displays my name and residential address or physical description of the property where the Student resides

Residency options

Valid Arizona driver's license, Arizona identification card or motor vehicle registrationValid U.S. passportReal estate deed or mortgage documentsProperty Tax BillResidential lease or rental agreementWater, electric, gas, cable, or phone billBank or credit card statementW-2 wage statementPayroll stub

Certificate of tribal enrollment or other identification issued by a recognized Indian tribe that contains an Arizona address.Documentation from a state, tribal or federal government agency (Social Security Administration, Veteran’s Administration, Arizona Department of Economic Security)Temporary on-base billeting facility (for military families)

I am currently unable to provide any of the foregoing documents. Therefore, I have provided an original affidavit signed and notarized by an Arizona resident who attests that I have established residence in Arizona with the person signing the affidavit.

Signature of Parent/Legal Guardian

Date

Upload image of document

Student Contract 2021-2022 Academic Year

I understand that admission to the Genesis Academy is a privilege; therefore, I will follow all regulations and policies as outlined in the Genesis Academy Student Manual.

Technology I also understand that it is possible that I might be using technology such as the internet to access, produce, publish and communicate information for research purposes. Along with this privilege, I will show respect for the technology and will use it appropriately or I will forfeit this opportunity. The signatures at the bottom grant my child access to the internet at Genesis Academy.

I will also abide by the following dress code: Only solid white, gray, black loose fitting shirts (no prints, stripes, or logos, shirts must have sleeves and cover front and back mid-section Free school shirts will be provided. Solid white, black, denim, gray sweat shirt or jacket. (No logos); jackets must be no longer than hip length; no long coats allowed. Solid white, black, gray or tan shoes (no bedroom slippers, ONLY black or white shoe laces) Plain khaki, black, denim, gray or white shorts, pants, or skirt (no logos; FOR GIRLS: skirts and shorts must be beneath fingertips when hands are held straight to the sides); jeans are acceptable. Plain white, gray, or black socks.

No gloves in classroom. No sunglasses in classroom. Parent/Guardian Consent I support my child's registration in the Genesis Academy and understand that I will be expected to attend information sessions and other activities connected to my child's success. I am also aware of all of the student policies outlined in the Genesis Academy Student Manual (including our policy on drug screening, zero tolerance on violence and search and seizure) and support the school's full enforcement of these policies as they pertain to my child. My child has my approval to enroll in college credit courses and I agree to the exchange of academic information between the participating institutions. By signing this form, I understand that the school may utilize my child's photographs or that my student may be filmed for marketing media and public relations (i.e., brochures, websites, advertising, TV news segments, etc

Upon your child's 18th birthday, the Academy may no longer release information to the

student's parent/guardian. Please have your child sign the following release in order to continue

receiving academic progress and behavioral information regarding your child after his/her 18th birthday.

Student Signature

Date

Parent/Guardian Signature

Date

2021-2022 Genesis Academy

PARENT/GUARDIANS