Enrollment Inquiry

5949 Fairington, Rd, Lithonia GA | Serving Early Learners to Afterschool Age

DISCOVERING
JOINING
LEARNING
- Early Education
- Elementary (Grades 1-5)
EXPERIENCING
BELONGING
- Parent Teacher Association
- Support

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ENROLLMENT INQUIRY FORM

If you have any questions about setting up a tour or about enrolling your child, please contact Ms. Tiffany via email at ChampionsAcad.ed@gmail.com or call 678-489-4117.

Student First Name

Student Last Name

Date of Birth

Student Age

Student Gender

Current School

Grade in Fall of 2023 *

Address

City

Region/State/Province

Postal / Zip code

Special Services Received * Required

None

Gifted & Talented

Occupational Therapy

Speech Therapy

Resource Room

Other

If other - Please describe

Does this child have an IEP? *

Yes

Has this child ever received disciplinary action resulting in missing school? *

Yes

If yes - Please describe

PARENT OR GUARDIAN INFORMATION

Guardian First Name *

Guardian Last Name *

Cell Phone

Email *

Address, if different than student

City

Region/State/Province

Postal / Zip code

Relationship to child

PLEASE ENTER NAMES OF OTHER CHILDREN INTERESTED IN ATTENDING CHAMPIONS ACADEMY

First Name (Child 2)

Last Name (Child 2)

Date of Birth

Age

Gender

Current School

Grade in Fall of 2023 *

Special Services Received

None

Gifted & Talented

Occupational Therapy

Physical Therapy

Speech Therapy

Resource Room

Other

If other - Please describe

Does this child have an IEP? *

Yes

Has this child ever received disciplinary action resulting in missing school? *

Yes

If yes - Please describe

First Name (Child 3)

Last Name (Child 3)

Date of Birth

Age

Gender

Current School

Grade in Fall of 2023

Special Services Received

None

Gifted & Talented

Occupational Therapy

Physical Therapy

Speech Therapy

Resource Room

Other

If other - Please describe

Does this child have an IEP?

Yes

Has this child ever received disciplinary action resulting in missing school?

Yes

If yes - please describe

How did you hear about us? * Required

Current CPA Family

Facebook

Twitter

Instagram

Google

Billboard

Thanks for submitting!

SCHEDULE TOUR

Location

5949 fairington Rd, Lithonia GA 30038

Phone

770-797-5377

ENROLL TODAY

Mon - Fri : 6:30 AM – 6:00 PM EST

Champions Preparatory Academy admits students of any race, color, nationality, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to Champions Preparatory Academy.

Champions Preparatory Academy does not discriminate on the basis of sex (as determined at birth and not subject to change), race, color, national or ethnic origin in the administration of our educational policies, admissions procedures, scholarship awards, athletic and other school administered programs. Champions Preparatory Academy does, however, reserve the right to deny admission to any individual who cannot benefit from enrollment based on past academic achievement, disqualifying handicap, doctrinal beliefs, or whose personal life-style is not in harmony with the stated philosophy and purpose of Champions Preparatory Academy.