Referrer Form "*" indicates required fields Student's Name* First Last Student's Birthday*Must be 4 years old on or by Aug. 31st 2022 MM slash DD slash YYYY Which Campus Are You Applying For?*Freedom (PreK-7th grade)Eastland (Prek-3rd grade)Southwest (PreK-1st grade)Legal Guardian's Name* First Last Legal Guardian's Phone*Legal Guardian's Email* Add a Secondary Guardian? Yes Secondary Legal Guardian's Name* First Last Secondary Legal Guardian's Phone*Secondary Legal Guardian's Email* Will you have another child enrolled at Movement Schools in the 22-23 school year? Yes No Do you currently qualify for Mecklenburg CCRI child care subsidies (vouchers)? Yes No Do you plan to apply for and qualify for Mecklenburg CCRI child care subsidy (voucher)? Yes No Does your child qualify for exceptional children services (service hours, speech, Occupational therapy, Physical Therapy, etc.)? Yes No HiddenReferrer Name First Last
