Heritage Peak Enrollment Interest Form
Desired Site Location	Please selectAbout F.A.C.E.Broadway Learning CenterElk Grove Learning CenterRio Linda Learning CenterVacaville Learning CenterWest Sacramento Learning CenterSutter Peak Charter
Student Name(last, first) *
2015-2016 Grade Level *	K123456789101112
Date of Birth *
Gender *	Male   Female
Address, City, State, Zip Code *
County of Residence *
Contact Phone Number *
Email
Last School Attended *
Parent/Guardian Name *	(Last, First)
Questions or Comments
How Did you Hear About Us?	Please selectFriendMagazineRadioOther
Special Education/IEP *	Choose one...YesNo
Do you know a staff member, if so who?

After clicking "submit" you will receive a confirmation e-mail assuring that your submission was received by HPCS. Enrollment packets will be available at the time of orientation. If you need assistance with this form, please call Lizet Rojas, Counseling Office Assistant, at (866) 992-9033 ext. 3030.

Please bring the following documents to orientation for enrollment: 1) Proof of Withdrawal from prior school 2) Report Card or Transcript(s) 3) Immunization Records 4) Incoming Kindergarten students (Copy of Birth Certificate - Children must be 5 years old before October 1, 2013/Report of Health and Dental Exam) 5) Copy of IEP (if applicable)