ODCS Enrollment Form

For questions or more information, please contact Dominique Cruz at 520-719-2007 or dominique@azyp.org

Enrollment Form Open Doors Community School

• Your Name*
  First Last
• Your email*
• Your phone number*
• Today's date*
  MM slash DD slash YYYY
• Your relationship to child (check one)*
  • Mother
  • Father
  • Foster Parent
  • Legal Guardian
  • Other (please specify below)
• Child's Name*
  First Last
• Child's phone number*
• Child's email address*
• Child's Biological Sex*
  MaleFemale
• Child's Date of Birth*
  MM slash DD slash YYYY
• Child's address
  Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Grade child last completed (Select one)*
  4th5th6th7th8th9th10th11th12th
• Is child currently in school*
  YesNo
• Language spoken at home*
  EnglishSpanishOther
• Specify Other language
• What is your child's race?*
  • Black or African American
  • White
  • Asian
  • American Indian/Alaska Native
  • Native Hawaiian or Pacific Islander
• What is your child's ethnicity?*
  Hispanic or LatinoNon-Hispanic/Non- Latino