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All items with an asterisk(*) are required.

If you have any questions or concerns while applying, please call our administrative offices at 248-745-9420.

Once the enrollment form is submitted you will be contacted for any additional information and documents required prior to final admission.

Has your child already attended Pontiac Academy for Excellence? To RE-ENROLL please click here

Student

*Last Name
*First Name
Middle Name
Alternate Last Name

*Gender

*Ethnicity

*Is your child's native tongue a language other than english?
 Yes No

If yes, what is that language?

Primary language(s) spoken at home?

*Birthdate

Birth Place:
*City: *State:

*Does your child attend a day care center or go to a sitter after school?

If Yes,

Name:
Address:
City: Zip Code:
Telephone:

School

*I wish to enroll my child in

*Has your child ever attended school before?

*Will your child require any of the following education services?
 Special education (IEP) Bilingual No special education services

Parent/Legal Guardian and family

*Phone Number where child resides

Address where child resides
*Street:
*City: *Zip Code:

*Adult MALE Parent/Guardian

*Work Phone Number
Cell Phone Number
E-mail Address

*Adult FEMALE Parent/Guardian

*Work Phone Number
Cell Phone Number
E-mail Address

Siblings

Please Fill in the text field below following the guide provided for all siblings that live in the same residence as the enrolling student:

Emergency Information

*Emergency Contact Person

*Relationship
*Phone Number
Cell Phone

*Emergency Medical Conditions/Problems:
Please check ALL that apply

*Will your child be taking medication during school hours?
 Yes No

If yes, a "Permission Form for Prescribed Medication" will need to be completed by parent/guardian and Physician. Forms are available in the Office.

Student Handbook Agreement

It is important for my/our child to achieve. Therefore I/we will encourage my/our child by doing the following:

  • See that my/our child is punctual and attends school on a daily basis.
  • Support the school in its effort to maintain proper discipline.
  • Encourage my/our child to be the best that he/she can be and maintain a positive attitude.
  • Maintain ongoing communication with the school and my/our child's teacher(s).
  • Attend parent/teacher conference and other functions.
  • Establish a time for sharing daily school experience and completing homework.
  • Encourage my/our child to respect others and their property.
  • I have read and agree to the rules and policies and consequences set forth by the Pontiac Academy for Excellence Handbook.

Media OK

Your child is on their way to becoming a lively part of the Pontiac Academy for Excellence community. Will you authorize us to use photo or video of your child to promote our school district?

I fully consent to and give Pontiac Academy for Excellence full authority to use in its discretion any and all media material containing my child's information (including but not limited to name, image, story, life circumstance, and/or data) and/or such information of any person for whom I am the legal guardian. I understand that this consent is full and absolute and I hereby give Pontiac Academy for Excellence the right to publish all such media materiel in every form possible including in agency promotional material, to distribute it directly or indirectly to the media at large, and/or post such material on Pontiac Academy for Excellence's website or any social media web pages.

Without limiting the generality of the above consent, I specifically authorize Pontiac Academy for Excellence to use the material indicated below in the manner stated above, subject to any specific limitation indicated below:

*I will allow:

Miscellaneous

How did you hear about us?

If Other:

Contact Us

We're not around right now. But you can send us an email and we'll get back to you, asap.

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