AliYah Academy

School Year

Let's get started! First, what school year are you registering for?

Registration Year

Has your family registered with us before? Yes, we've signed up before No, this is our first time to sign up

Family Information

Next, let's get some information about your family. We'll need your name, current street address, and the best way to reach you.

Father/Guardian's Name Father's First Name Father's Last Name

Mother/Guardian's Name Mother's First Name Mother's Last Name

Address Street Address

City State ZIP Code

County Country

Contact Information Phone Alternate Phone Email

Are you a member of Home School Legal Defence Association (HLSDA)? Yes No HSLDA Account Number

Are you a member of a co-op or support group? Yes No Co-Cop Name

Student's Information

Student's First Name Student's Middle Name Student's Last Name

Birth Date Grade

Sex Male Female

Special Needs? Yes No Special Needs

Is this student transferring from another school? (Umbrella or traditional) Yes No

Required Records

Birth Certificate I'll mail a copy

Vaccine Records or Exemption Letter I'll mail a copy

To request the transfer of your student's records, we need to contact the previous school they attended.

School Address School Name School Street Address

City State ZIP Code

School County Country

School Contact Information School Phone School Fax

AliYah Academy Registration Form