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 Name Middle Name Last Name
Parent/Guardian Name *

First Name Middle Name Last Name
Student's Birth Date *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

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

Area Code Phone Number
Parent/Guardian Phone Number *

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

Yes No
What Clubhouse are you affiliated with? *

Abbe Harriman Gerry
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: