O'Farrell Community School

1. Grade Level: K 1 2 3 4 5 6 7 8 9
   (Please indicate the grade that applicant will be entering September, 2012)

1. Last Name*: First Name *: Middle Name:
2. Date of Birth*: Place of Birth *: Male Female
   (City, State, Country)
3. Current Grade: Current School: City: State:

1. Last Name*: First Name *:
2. Mother Father Guardian
3. Last Name: First Name:
4. Mother Father Guardian
5. Street address *: City *: State *: Zip *:
(list primary parent address)
6. Do you have a sibling attending O’Farrell presently? If yes, name:
7. Preferred Home Phone Number: Preferred Work Phone Number:
8. E-mail address: Cell Phone:

Open Enrollment period: December 1, 2011 – March 30, 2012.
O’Farrell Community School registration is held throughout the summer if classes do not fill by March 30, 2012
Final offers for enrollment will be granted upon completion of the intake interview and submission of any necessary enrollment documents, including student’s immunization and school records.

9. Parent Signature *: Date *:
10. Received by : Date received :

A Charter school is a publicly funded school that is self-governed by staff, parents and members of the community. I/We understand that my child will be attending a California Charter School (Initial)

The Board of Directors (governing board of O'Farrell Community School) has mandated expectations for student behavior that are part of the requirements for admission. Violation of the requirements can result in disenrollment from the Charter School. By signing this application you are agreeing to support the requirements and abide by the expectations.

Enrollment Requirements:

I/We:

• request the student be considered for O'Farrell Community Charter School for the 2012-2013 school year.
• understand that enrollment will be offered on a space-available basis by the school.
• understand that if my student is enrolled, he/she must remain at O'Farrell until the completion of the school year he/she begins.
• certify that all the information provided in this application is accurate.
• understand that O'Farrell Community School can deny or revoke my child's admission or enrollment if any information is found to be incomplete or inaccurate.
• understand there is no transportation provided.
• understand that O'Farrell Community School is a school of choice and that by signing this application for admission and upon acceptance to the school, we will become familiar with and agree to abide by all policies and procedures set forth in the parent-student handbook.
• will read and abide by the O'Farrell Uniform Policy.
• have read and understand the O'Farrell Charter School application agreement.
• understand that due to enrollment limitations, a lottery will be implemented if maximum class capacity is reached.

1. Date*:
2. Parent Name *:
3. Child's Name *: