Masterpiece Academy Application Please get in touch with the school administrator at A.J. Lewis Greenview Elementary School for eligibility. Child's Name * First Name Last Name Date of Birth * Gender * Race * Parent's/Guardian's Name * First Name Last Name Spouse's Name (if applicable) First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Cell Phone (###) ### #### Email Emergency Contact: Name * First Name Last Name Phone * (###) ### #### Relationship to child * Child's Favorite Subject: * Child's Food Allergies * (if not applicable please say so in the box below) Child's Seasonal Allergies: * (if not applicable please say so in the box below) People allowed to receive information concerning Child: People allowed to pick up Child: (if applicable) Child's T-shirt size * I give permission for my child to participate in Masterpeice Academy and support this initiative for my child. I agree to allow my child's picture to be taken and used by Pure Dominion Ministries, as their property, for program awareness/promotion. * (If you agree type your name below as your electronic signature) Date MM DD YYYY Thank you for your application.
