New Student Returning student last attended session/year:
New family

If enrolling more than one student, please attach separate sheet with all necessary information.

Student's last name:

First name:

Middle name :

Age:

Gender:

Social Security number:

c/o:

Address:

City:

State:

ZIP:

Name of school:

School_City

E-mail:

Grade entering

School programs involved in now?

Carroll Academy Teacher (if current student):

Previous experience (if new to the program):

Where did you hear about us?

Mother's name

Father's name

Address (if different from above)

Home phone:

Parent/Guardian cell:

Mother business phone:

Father business phone:

Name of participant's physician:

Physician phone number:

Allergies:

Treatment/care required:

Other? Please identify with specificity:

I have read and understand the policies.
I have completed and signed the release, waiver and consent form.
Check enclosed for $
Please charge $

Visa MasterCard American Express

Card number: Expiration date:

Signature: Date:

New lesson students: Please include a listing of all available times for lessons and a description of the student, detailing special needs and interests.
Returning students: Communicate need for change of times directly with your teacher.

Session attending: Fall Spring Summer

Title of course:

Location:

Class fee:

Additional information/comments:

Title of course:

Location:

Class fee:

Additional information/comments:

Title of course:

Location:

Class fee:

Additional information/comments:

Title of course:

Location:

Class fee:

Additional information/comments:

Please mail check, this application, a completed release, waiver, and consent form, as soon as possible to: Carroll College Academy, 100 N. East Ave., Waukesha, WI 53186 

For Office Use Only: