Boca Raton Charter School is an official I.B. Candidate School offering the Primary Years Program.  To apply please print this application, sign, date and send to the address listed below. I. Student Application Form Child’s Name First__________________________________ Middle______ Last ______________________________________________ Address ___________________________________________ City__________________________State________Zip______ Gender ( ) Male ( ) Female Soc. Sec. Number___________________________ Age_______ Date of Birth ______Place of Birth______________________ Home Language ___________________________________ Application for FY  2011/2012 ___  Grade Level: (Check one) ( ) Pre kindergarten [ age 3 or 4 and potty trained] ( ) Pre kindergarten Voluntary Pre-k  [ age 4 on or before     September 1st, FY___ 2011-2012 ] ( ) Kindergarten     [must be age 5 on or before September 1st [FY 2011/2012]  ( ) 1st Grade ( ) 2nd Grade ( ) 3rd Grade ( ) 4th Grade ( ) 5th Grade ( ) 6th Grade II. Parent Information: Mother Information: Name _______________________________________ Address ______________________________________________ City ___________________________State______ Zip________ Phone Numbers and Contact Information: Home(_____)_________________Alternate (_____)__________ Business (_____)_________________ Cell (_____)___________ Fax (_____)_____________ Email_________________________ Father Information: Name __________________________________ Address______________________________________________ City____________________________State______ Zip_______ Phone Numbers and Contact Information: Home (_____)_________________Alternate (_____)__________ Business (_____)_________________ Cell (_____)____________ Fax (_____)________________ Email ______________________ Phone Numbers and Contact Information: III. Previous School: ( ) NA ( ) Public ( ) Private ( ) Home School International Baccalaureate ( ) Yes ( ) No Current School or Designated Palm Beach County School Name of School ______________________________________ Address____________________________________________ City ____________________ State ________Zip _________ Special Services/Accommodations. Please check all that apply. Does your child have an I.E.P.? (Individual Education Plan) Yes ____ No _____ Does your child receive Speech/Language Services? Yes ___ No ____ Does Your child have a 504 Plan? Yes ____ No ____ Does your child have an L.E.P. Plan? Yes ___ No ____ (Limited English Proficiency) Is a language other than English spoken at home? Spanish __ Portuguese ___ French ___ Creole ___ Other _________________________________ Previous School: Contact Information Telephone Number(____)_______________________________ Fax Number (____)_____________________________________ Grade Level attending in  _______ 2011-2012 Parent/Guardian Signature___________________________ Date:____________________ Print and complete this form. Mail to the school at the address below. Boca Raton Charter School  * 269 N.E. 14th Street * Boca Raton, Florida  33432 Fax 561-750-7880