New Beginnings Family Academy

184 Garden Street, Bridgeport, CT 06605 - Phone: 203-384-2897 Fax: 203-384-2898
	Our Mission and Culture News Events Academic Calendar Board of Directors Staff Directory Job Listings Application for Admission Application for Reenrollment Newsletters Classes / Homework Departments Staff Directory / Email Classes / Homework Food Menu Links Photo Album Student and Parent Handbook Application for Free or Reduced Price Meals or Free Milk Emergency Contant Form Powerschool Application for Admission Application for Reenrollment News Events Bulletin Board PTA Directory/Email Student and Parent Handbook Application for Free or Reduced Price Meals or Free Milk Emergency Contant Form Powerschool Friends of NBFA Contribute
	Applications for admission AND reenrollment must be received NO LATER THAN APRIL 9 for your child to be considered for the 2010-2011 academic year.
	EMERGENCY CONTACT FORM Complete all information - one form for each child attending NBFA. Mandatory fields marked * Child's Name: * Gender: * Male Female Birth Date: * Grade: * Address: * Apt #: * City: * Zip: * Email address: * Home phone #: * Business phone #: * Name of child’s parent(s)/Guardian(s) 1. Name: * Relationship to child: * Phone numbers: Home * Cell * Work * 2. Name: * Relationship to child: * Phone numbers: Home * Cell * Work * Child lives with these adults Check all that apply: Mother Father Step-Mother Step-Father Grandmother Grandfather Significant Other Foster Family Please list other brothers and sisters attending NBFA 1. Name Grade 2. Name Grade 3. Name Grade 4. Name Grade In case of an emergency please list as many contact numbers as possible (at least two). These people must be able to respond to the emergency and come to school. List contacts in the order we should call. 1. Name * Relationship * Phone #1 * Phone #2 * 2. Name * Relationship * Phone #1 * Phone #2 * 3. Name * Relationship * Phone #1 * Phone #2 * Who is allowed to take your child from NBFA before school ends or at dismissal? We will ask for photo identification. 1. Name * Relationship * Phone #1 * Phone #2 * 2. Name * Relationship * Phone #1 * Phone #2 * 3. Name * Relationship * Phone #1 * Phone #2 * Student’s Physician * Phone * Hospital where student should be taken if parent or physician is unavailable : Allergies or other medical conditions : I certify the information above is complete and accurate. Please print your name: Parent /Guardian Signature Date:
	© New Beginnings Family Academy. 184 Garden Street, Bridgeport, CT 06605 - Phone: 203-384-2897 Fax: 203-384-2898