Primary Contact Information

First name

Last name

Email

I agree to be contacted for studio communications and updates

Primary Contact Phone

Address

How did you hear about us?

Emergency Contacts

Primary Emergency Contact

Primary Emergency Contact Phone

Relation to Student

Secondary Emergency Contact

Secondary Emergency Contact Phone

Relation to Student

Student Details

Student 1 Name

Student 1 Birthday

Month

Day

Year

Student 1 Sex

New or Returning Student?

Grade Level Applying For:

Please share previous education experience:

Please share any medical conditions or learning needs:

Is this student planning to enroll in Discovery Day (Friday) courses?

Yes

No

Is this student planning to enroll in performing arts courses through Bridgeman Academy?

Yes

No

Optional Services

Do you plan to use before/after care services?

Before Care (7:00–8:45 AM): Daily $25

After Care (3:45–5:00 PM): Daily $25

None

Unsure

School Lunch Plan

Yes, Full-Year Lunch Plan ($400 per student)

Yes, Occasional Lunch ($5 per student per day)

No Lunch Plan

Signature & Consent

By signing below, I confirm that the information provided is accurate and complete. I understand that submitting this application does not guarantee acceptance; final enrollment is contingent on program space and acceptance by Bridgeman Academy/SynergyEd Academics.

Signature

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Apply for our K-12 Education Program

Primary Contact Information

Emergency Contacts

Student Details

Optional Services

Signature & Consent