Child's Name

Child's Name

Address

Gender

Gender

Gender

Home School District

Grade in 21-22

Areas of Interest

Areas of Interest

Dance

Dance

Dance

Vocal Music

Theatre

Design & Digital Art

Musical Theatre

Figure Skating

Instrumental Music

Parent/ Guardian's name

I understand that the Pocono Charter High School for the Performing and Visual Arts will service students from Mt. Pocono & surrounding counties.

I further understand that this school will focus on a variety of visual and performing arts along with a strong academic program. I further understand that this is a preliminary application, non-binding and indicative of my interest and support for this school.

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Please Type Signature in Box Below:

I have read and understand the statement above

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