Student’s Name *

First Name

Last Name

Parent or Guardian Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Will you be using charter funding to pay tuition? *

No

Yes - Clarksville

Yes - Cottonwood

Photo Consent *

Do you consent to have student's photo posted on social media and marketing tools?

Yes

No

If you answered "Yes" above:

Check all boxes that apply to what type of photos you consent to being posted on social media and marketing tools.

Hands

Face

Full body