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Reenrollment Form

NBFA REENROLLMENT FORM

DUE FRIDAY April, 08,2022

(Please complete a separate form for each child)

184 Garden Street Bridgeport, CT 06605 • T: (203) 384-2897

Contact Information

Child's First Name

Answer Required

Child's Middle Name

Answer Required

Child's Last Name

Answer Required

Date of Birth

Answer Required

Child's Gender

Answer Required

Male

Female

Will your child reenroll at New Beginnings Family Academy?

Answer Required

Yes

If YES, fill out the following.

(If no skip to the end.)

What grade will your child be in next year?

Answer Required

Does your child have any siblings at NBFA

Answer Required

Yes

Parent/Legal Guardian (1)

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Email 1

Answer Required

Mobile Phone

Answer Required

Home Phone

Answer Required

Work Phone

Answer Required

Parent/Legal Guardian (2)

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Email 1

Answer Required

Mobile Phone

Answer Required

Home Phone

Answer Required

Work Phone

Answer Required

Emergency Contact Information

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Phone

Answer Required

If you are undecided on whether your student is returning or not please check here.

Answer Required

Undecided

If your answer was no, please fill out the following.

Why is your child leaving?

Answer Required

Where should we send your child's school records?

Answer Required

NOTE: By withdrawing your child, you are permanently forfeiting his/her seat at New Beginnings Family Academy and there is no guarantee of reenrollment at a later date.

Today's date

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Confirmation Email

Email Required