New Student Application Request (1st – 5th)

New Student Application Request

Thank you for your interest in the Madelaine Halmos Academy! In order to apply, please read and follow these instructions:

Please complete our online application below.
Additionally, please upload a copy of your child's most recent report card to the application. If you have trouble uploading, email the report card to enrollment@jackandjillcenter.org.
Once the application and report card are received, someone from our school will be in contact with you to discuss next steps.If you are interested in taking a tour of the new Madelaine Halmos Academy building, contact us by phone at (954) 463-8772, x218 or by email at enrollment@jackandjillcenter.org.

Elementary Education Application 1st - 5th Grade

"*" indicates required fields

Application for School Year*

Entering Grade*

Please upload a copy of your child’s most recent report card or progress report*

Max. file size: 10 MB.

Student's Name*

First Last

Gender*

Child's Date of Birth*

Address*

Street Address City State Zip Code

Country of Citizenship*

Ethnicity*

Race*

Would you like to register another student living at the same address?*

Application for School Year

Please upload a copy of your child’s most recent report card or progress report

Max. file size: 10 MB.

Student 2 Name

First Last

Gender

Child's Date of Birth

Country of Citizenship

Ethnicity

Race

Parent Information

Marital Status of Natural Parents*

With Whom Does the Student Live*

Who Has Legal Custody*

Parent/Guardian 1

Parent/Guardian 1*

Name*

Prefix First Last

Email*

Address (if different from above)

Street Address City State ZIP Code

Primary Phone Number*

Primary Phone Type

Secondary Phone Number

Secondary Phone Type

Employer*

Occupation*

Parent/Guardian 2

Parent/Guardian 2*

Name

Prefix First Last

Address (if different from above)

Street Address City State ZIP Code

Parent/Guardian 2 Primary Phone Number

Primary Phone Type

Parent/Guardian 2 Secondary Phone Number

Secondary Phone Type

Parent/Guardian 2 Employer

Parent/Guardian 2 Occupation

Additional Information Required

Last School Attended

Principal/Director

School Address

Street Address City State Zip Code

School Phone

How Long at Last School

Reason for Leaving

Special Medication or Medical Condition*

Has your child been identified as gifted/talented or double promoted?*

Has your child ever been referred/evaluated for physical, developmental, academic, social or psychological concerns?*

Has your child experienced any discipline/conduct problems, grade retention(s), school suspensions, and/or dismissals?*

If ‘Yes’ to any of the above, please explain here:

How did you hear the Maddelaine Halmos Academy?*

Full Name of Parent/Guardian Submitting Form:*

Today's Date*

Comments

This field is for validation purposes and should be left unchanged.