Fall 2021 BCNY Family Academy Registration Form

Fall 2021 BCNY Family Academy Registration Form

Family Academy is a 6 part series to learn more about the high school admission process with BCNY High School Access Team. Families of members and non-members are welcome to attend!
Student's Name*

First NameMiddle NameLast Name
Parent/Guardian Name*

First NameMiddle NameLast Name
Student's Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student's E-mail
Parent/Guardian Email*
example@example.com
Student's Phone Number

Area CodePhone Number
Parent/Guardian Phone Number*

Area CodePhone Number
Current Grade*
Are you a current BCNY member?*

YesNo
What Clubhouse are you affiliated with?*

AbbeHarrimanGerry
If not a current member, which Clubhouse are you closest to?*

Abbe (13301 41st Rd, Flushing, NY, 11355)Gerry (321 E 111th St, NY, NY 10029)
Should be Empty: