<p> Camden Academy Charter High School 879 Beideman Avenue Camden, NJ 08105 Application for Lottery Grades 9-12 NAME OF STUDENT NAME OF PARENT/GUARDIAN ADDRESS OF PARENT/GUARDIAN BIRTHDATE OF STUDENT GRADE CURRENTLY ATTENDING GRADE APPLYING FOR School Year SCHOOL CURRENTLY ATTENDING DAY PHONE NUMBER(S) EVENING PHONE NUMBER(S) EMERGENCY CONTACT PERSON RELATIONSHIP TO THE STUDENT EMERGENCY CONTACT PHONE #</p><p>If any of this information changes, please note, it is your responsibility to contact the school at (856) 365-1000, ext. 108 and update your information. If you have any questions about the lottery, please call the school.</p><p>Please answer the following questions:</p><p>Does the student have any siblings that are currently attending or have attended Camden Academy Charter High School? Please list:</p><p>Does the student have any siblings that have not yet entered to the Ninth grade? Please list, along with others and current grades:</p><p>By completing and returning this form to Camden Academy Charter High School, I the parent/guardian, acknowledge my consent for my child’s/children’s name (s) to enter the charter school’s admissions lottery. Upon my child’s acceptance, I will request the release of my child’s records from their current school to Camden Academy Charter High School.</p><p>Parent/Guardian Signature: ______Date: ______</p><p>FOR OFFICIAL USE ONLY</p><p>Date Received: _____/_____/____ Next Lottery Date: _____/______/______</p><p>Received by: ______</p><p>Communication: ______</p><p>______. Camden Academy Charter High School agrees to serve all students and allow no discrimination based on race, ethnic identity, cultural heritage, intellectual capacity, measures of achievement, status of a handicapped person, language proficiency, or any other practice deemed unethical.</p><p>Student Name______Grade applying for______</p><p>Date Received: ____/_____/_____ Next Lottery Date: ______/_____/______</p><p>Received by: ______</p><p>** Reminder If you have any questions about the lottery or if any of the information listed above changes, it is your responsibility to contact the school at (856)365-1000 ext 108 and update the information.</p>