cleverclassdojo

Mr. Timothy Simmons
Interim Chief School Administrator
973-373-3223
bcse@​burchcharterschool.org
100 Linden Avenue Irvington, NJ 07111
100 Linden Ave.,Irvington NJ, 07111
 
Mr. Timothy Simmons
Interim Chief School Administrator

Student Enrollment Form

Burch Charter School of Excellence

2023 - 2024 Online Pre-Registration Form


 

Student's Last Name *Please enter student's last name
Student's First Name *Please enter student's first name
Address *
City *
State *
ZIP *
Home Phone
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    Cell Phone
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      Date of Birth *
      Sex*
      M
      F
      Age (As of Oct.1, 2023 *
      Current School Attending
      Current Grade
      Grade Entering in Sept 2023
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      Parent Information

      Mother's Information

      Mother's Name
      Mother's Address
      Mother's Home Phone Number
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        Mother's Work Phone Number
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          Mother's Cell Phone Number
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            Father's Information

            Father's Name
            Father's Address
            Father's Home Phone Number
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              Father's Work Phone Number
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                Father's Cell Phone Number
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                  Sibling Information

                  Brothers and sisters in order of age (Oldest to youngest)

                  Name
                  Date of Birth
                  Grade for Sept. 2023
                  Sex
                  M
                  F
                  Name
                  Date of Birth
                  Grade for Sept. 2023
                  Sex
                  M
                  F
                  Name
                  Date of Birth
                  Grade for Sept. 2023
                  Sex
                  M
                  F
                  Name
                  Date of Birth
                  Grade for Sept. 2023
                  Sex
                  M
                  F
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                  Certification

                  Please provide your name, email address and check the certification box.

                  I certify that the information provided on this BCSE Pre-Registration form is accurate*
                  Name *
                  Email *
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