3211 Bramer Drive, Raleigh, NC 27604 // Phone: (919) 850-9960 Fax: (919) 850-9961

Student Enrollment Application

Student's First Name *

Student's Middle Name

Student's Last Name *

Student's Home Address *

City, State *

Zip Code *

Date of Birth *

Student's Gender

MaleFemale

Student's current age *

What is the Name of the current school your child is attending? *

Current School *

City, State, Zip *

Student's current grade *

Grade applying for school year 2017-2018 *

How did you hear about Torchlight Academy? *

Father's First and Last Name *

Father's home phone number *

Father's cell phone number *

Mother's First and Last Name *

Mother's cell phone number *

Mother's home phone number *

Email Address *

With whom does student currently live? *

What language is most often spoken in your home? *

Name of emergency contact person *

Emergency contact home number*

Emergency contact cell number

What is the relationship of the emergency contact to the student (ex. grandparent, aunt...)

Will parent/guardian provide transportation to and from school?

By submitting this form, I certify that all of the above information is accurate. I give Torchlight permission to request information about my child from his current/former schools. I understand that Torchlight Academy can deny or revoke admission or enrollment if any information is found to be incomplete or inaccurate. A confirmation letter will be sent to confirm acceptance to Torchlight Academy. *