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Global Outreach Charter AcademyPacket A9570 Regency Square Boulevard * Jacksonville, FL 32225(904) 551-7104 * (904) 551-7120 (fax) * www.gocacademy.orgKINDERGARTENDOCUMENTS REQUIRED FOR REGISTRATIONIn addition to picture ID, the following documents must be presented at the time of registration:Certified Birth CertificateChild must be 5 years old by September 1, 2019.Social Security NumberPhysical Exam (on DH Form 3040 provided by doctor/clinic)Must be current within 12 months of enrollmentImmunizations (on DH Form 680 provided by doctor/clinic)Completed Hepatitis B Vaccination Series; 2 MMR Shots, 4 DTP (if 4 th dose given before4th birthday a 5th dose is required), 3 polios (if 3rd dose given before 4th birthday a 4thdose is required), Varicella Vaccine (Chicken Pox) or proof of having had the disease or avalid exemption from the DoctorProof of Address (one required from each number)1. JEA or TECO bill, Mortgage Agreement, Lease Agreement (if from private individualmust be notarized), Driver’s License2. Auto insurance, credit card statement, bank account statement, postal service changeof address, payroll statement, non-cellular phone billSchool Records (if child retained in Kindergarten last year)The most recent Report Card showing retained.NOTE: Exceptional education students need to provide a copy of the most current IEP.If the student is enrolled at a Duval County Public School when Global Accepts the studentapplication to attend, the parent must go to the Duval County Public School and withdraw thestudent, then bring the withdraw form to Global.These documents must be provided at the time of registration. Should you have questions or requireadditional information, please call Student Records @ 904-551-7104, extension 105.Comments:Forms: Blue Card, Enrollment Form, Authorization to Enroll, PE Permission, Media Permission, School Choice, Parent Contract,Health Questionnaire, Free & Reduced Lunch

Packet BGlobal Outreach Charter Academy9570 Regency Square Boulevard * Jacksonville, FL 32225(904) 551-7104 * (904) 551-7120 (fax)www.gocacademy.org1st – 8th GradesNever attended a DuvalCounty PUBLIC SchoolDOCUMENTS REQUIRED FOR REGISTRATIONIn addition to picture ID, the following documents must be presented at the time of registration:Certified Birth CertificatePhysical Exam (on DH Form 3040 provided by doctor/clinic)Must be current within 12 months of enrollmentImmunizations (on DH Form 680 provided by doctor/clinic)Completed Hepatitis B Vaccination Series; 2 MMR Shots, 4 DTP (if 4 th dose given before4th birthday a 5th dose is required), 3 polios (if 3rd dose given before 4th birthday a 4thdose is required), Varicella Vaccine (Chicken Pox) or proof of having had the disease or avalid exemption from the DoctorStudents entering7th & 8th gradeAll students entering 7th or 8th grade must provide an updatedImmunization Record showing the Tdap booster.Proof of Address (one required from each number)1. JEA or TECO bill, Mortgage Agreement, Lease Agreement (if from private individualmust be notarized), Driver’s License2. Auto insurance, credit card statement, bank account statement, postal service changeof address, payroll statement, non-cellular phone billSchool Records (if child retained in Kindergarten last year)Elementary: The most recent Report Card showing promoted/retained and grade level.Middle School: Final Report Cards for 6th, 7th, and 8th grades (as applicable).NOTE: Exceptional education students need to provide a copy of the most current IEP.These documents must be provided at the time of registration. Should you have questions or requireadditional information, please call Student Records @ 904-551-7104, extension 105.Comments:Forms: Blue Card, Enrollment Form, Authorization to Enroll, PE Permission, Media Permission, School Choice, Parent Contract,Health Questionnaire, Free & Reduced Lunch

Packet CGlobal Outreach Charter Academy9570 Regency Square Boulevard * Jacksonville, FL 32225(904) 551-7104 * (904) 551-7120 (fax)www.gocacademy.org1st-8th GradesCurrently attending a DuvalCounty PUBLIC School.DOCUMENTS REQUIRED FOR REGISTRATIONIn addition to picture ID, the following documents must be presented at the time of registration:Proof of Address (one required from each number)1. JEA or TECO bill, Mortgage Agreement, Lease Agreement (if from private individualmust be notarized), Driver’s License2. Auto insurance, credit card statement, bank account statement, postal service changeof address, payroll statement, non-cellular phone billWhen Global accepts the student application to attend, the parent must go to the DuvalCounty Public School and withdraw the student, then bring the withdraw form to Global.Students entering7th gradeAll students entering 7th or 8th grade must provide an updatedImmunization Record showing the Tdap booster.These documents must be provided at the time of registration. Should you have questions or requireadditional information, please call Student Records @ 904-551-7104, extension 105.Comments:Forms: Blue Card, Enrollment Form, Authorization to Enroll, PE Permission, Media Permission, School Choice, Parent Contract,Health Questionnaire, Free & Reduced Lunch

Global Outreach Charter Academy #122Tuition-Free Public School9570 Regency Square Boulevard * Jacksonville, Florida 32225Tel: 904 - 551-7104 * Fax: 904 - 551-7120www.gocacademy.comWelcome to Global Outreach Charter Academy!To keep our school’s communication with parents at the highest level, please provide us with thefollowing information:Child’s Name (Last, First, Middle):Address:Date of Birth: Year Month DayRace:Student lives with: Both Parents Mother Father Stepmother StepfatherGuardian Foster OtherFather Name:Work Phone: Cell Phone:Mother Name:Work Phone: Cell Phone:Parent Email: (Please write legibly)How did you hear about us?Parent/Guardian Signature: Date:Office Use OnlyApplication checked byDate:The Mission of Global Outreach Charter Academy is to deliver a first-class academic program that offers a unique foreign language andmulticultural curriculum, empowering students to have a competitive edge in the global vision.

Duval County Public SchoolsEmergency Contact Information and Authorization for Release of Student from SchoolINSTRUCTIONS: Parent/Guardian/Surrogate please complete and return to school. Signature and date are required.Student Legal Name (last, first, middle)Date of BirthStudent #SchoolGradeHomeroomStudent Address: House number and street name, apartment #, city, state, zip code, housing development name (if applicable)Emergency Contact Information and Authorization for Release of Student from School:1.2.3.4.5.PRINT all information.INCLUDE EACH PARENT/GUARDIAN/SURROGATE ON THIS LIST. Circle the appropriate relationship to student.List all contacts who may act on your behalf in case of sudden illness, accident, or emergency.List names in the order they should be contacted.The school will also use this information to determine who may pick up your student from school (non-emergency).Daytime ContactEmergencyLast NameFirst NameRelationship to StudentContact?Phone SNOHealth Screenings: Students will receive non-invasive health screeningspursuant to Florida Statute 381.0056. Non-invasive screenings mayinclude vision, hearing, scoliosis and growth and development(height/weight). These tests may be given individually or in groups.Parents or guardians, however, have the right to request an exemption inwriting. If you DO NOT want your child to receive any or all of thescreenings, write the words “Do Not Screen” in the boxes on the right thatapply.Does the student have allergies? YesIf yes, please list below:NoPick up from wth and Development:List any health conditions including but not limited to heart disease, diabetes, asthma,epilepsy, eye or ear problems:Current medications:Doctor/ Primary Health Care Provider:Name:Phone:Fax:I hereby give consent for my child to participate in the School Health Service Program and to receive nursing and emergency care at the school, if needed. Screening and evaluationfor problems in the areas of vision, hearing, growth and development, nutrition, dental, scoliosis, communicable diseases, blood pressure, speech and language, or other noninvasive health screenings may be done as part of the program.In the event of a serious accident or illness, I request that the school contact me. If I cannot be reached, I request designated school personnel to take or send my child to the hospitaldetermined by Emergency Services personnel. I consent to be responsible for all expenses incurred. In case of an accident or illness where immediate medical treatment isnot indicated, but where my child is unable to remain in school, I request the school contact me. If I cannot be reached, I request that one of the persons listed above be contacted toremove my child from school and to be responsible for his/her care. These persons listed have transportation and are immediately available to come to school.The Florida Department of Health-Duval in conjunction with the Department of Education provides school health nursing services for Duval County Public Schools. I understand thatall health-related information I provide to the school regarding my child will be shared between the two agencies as needed in the performance of their duties. I further understand thatsaid information will be shared between agencies in compliance with state and federal laws governing student records and confidentiality requirements.PRINT Parent/Guardian/Surrogate NameParent/Guardian/Surrogate SignatureDateEm Contact and Auth to Release formREV052017

Global Outreach Charter Academy #122Tuition-Free Public SchoolSCHOOL YEAR 2017-20189570 Regency Square Boulevard * Jacksonville, Florida 32225Tel: 904 - 551-7096 * Fax: 904 - 551-7120www.gocacademy.comBOTH SIDES OF THIS FORM MUST BE FILLED OUTStudent lives with Both Parents Mother Father Stepmother Stepfather GuardianFoster OtherParent Email: (Please write legibly)List Sibling(s) in this School:In the event your child is not able, or only partially able, to take part in the regular PhysicalEducation program, please check the degree of participation permitted below:Full ParticipationLimited Participation (must be explained below for us to excuse the student)Non-Participation (must submit a signed letter from physician for us to excuse the student)Reason:In case of emergency, please indicate what is the hospital of your choice and if the child is insured.HOSPITAL CHOICE:InsuranceBOTH SIDES OF THIS FORM MUST BE FILLED OUTThe Mission of Global Outreach Charter Academy is to deliver a first-class academic program that offers a unique foreignlanguage and multicultural curriculum, empowering students to have a competitive edge in the global vision.