Terrence S. Mixon, Sr., Executive Director Mobile County ... · CHURCH SCHOOL ENROLLMENT FORM...

CHURCH SCHOOL ENROLLMENT FORM

School Year: Public School District:

Part 1 – To be completed by Parent or Guardian

Student’s Name: Date of Birth: Grade:

Parent or Guardian’s Name: Phone:

Address: City: State: Zip:

Date: Signature of Parent or Guardian:

Part 2- To be completed by Church School Administrator

Church School Name: School Phone

Address: City: State: Zip:

Date of Enrollment: Signature of Church School Administrator:

Part 3- Consent of Notification of Student Withdrawal

I hereby give prior consent to the Church School Administrator to notify the Public School Superintendent

MCPSS Attendance Department P.O. Box 180069 Mobile Al 36618 should the above named student cease

attendance at said church school.

_________________ _________________________________

Date Signature of Parent or Guardian

Approved Denied - Return to Parent or Guardian

P.O. Box 180069 • Mobile, AL 36618 • www.mcpss.com SUPERINTENDENT Martha L. Peek

Terrence S. Mixon, Sr., Executive Director

DIVISION OF STUDENT SUPPORT SERVICES

Curt Belson, Supervisor

ATTENDANCE SERVICES DEPARTMENT

Phone: (251) 221-4276

Fax: (251) 221-5390

Email: clbelson@mcpss.com

Email: lbiggs@mcpss.com

Mobile County Public School System