M.O.T. Academy - 14202 S.W. 62 Street, Miami FL 33183
(786) 299-5915
info@motacademy.com
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Home
Our School
Why M.O.T.
M.O.T. Academy
Mission & Values
Admission
Registration Form
Faculty & Staff
Resources
Galleries
Calendar
2024-2025 Academic Calendar
CREDIT RECOVERY PROGRAM
M.O.T. Academy Registration
Welcome to M.O.T. Academy
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M.O.T. Academy Registration
Registration Form
M.O.T. Academy Registration Form
M.O.T. Registration Pack
Personal Information
Authorized Pick Up & Previous School
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Release of Liability
Medical Information
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CC Authorization
Bank Authorization
Photo Waiver
Miscellaneous
Current Doctors
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STUDENTS PERSONAL INFORMATION
First Name
*
Last Name
*
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
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New Hampshire
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New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code (ZIP)
*
Birthdate (mm/dd/yyyy)
*
Age
SSN
*
MOTHER'S PERSONAL INFORMATION
Lives w student
Lives with the student
First Name
Last Name
Street Address
City
State
Florida
Postal Code (ZIP)
Mother's E-mail
SSN
Ocupation
Employer's Name& Phone
Years in Current Occupation
Phone Numbers
Phone
Add
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FATHER'S PERSONAL INFORMATION
lives w student
Lives with the student
First Name
Last Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code (ZIP)
Father's E-mail
SSN
Ocupation
Employer's Name& Phone
Years in Current Occupation
Phone Numbers
Phone
Add
Remove
GUARDIAN'S PERSONAL INFORMATION
lives w student
Lives with the student
First Name
Last Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code (ZIP)
Guardian's E-mail
SSN
Ocupation
Employer's Name& Phone
Years in Current Occupation
Phone Numbers
Phone
Add
Remove
Parent Status
*
Married
Separated
Divorced
Widowed
Single
In case of divorce or separation, who has legal custody of child
Mother
Father
Guardian
Is there a restraining order or legal issue
*
YES
NO
If yes, Please submit a copy of the appropriate legal document(s) regarding this court order
CANNOT PICK UP CHILD AT SCHOOL
Mother
Father
Signature
*
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