705 Edgewood Street, N.E.
Washington, D.C. 20017
Phone: 202-938-1416
Fax: 202-204-5706
www.capitalvillageschools.org
SEAT ACCEPTANCE FORM
2021-2022 SCHOOL YEAR
Parents/Guardians: Please complete this form to confirm your child accepts a seat at Capital Village Public
Charter School and submit it with other enrollment requirements to the school in person or online.
STUDENT INFORMATION-You must fill out one form for each child enrolling.
First and Last Name:
Date of Birth (MM/DD/YYYY):
Current School (2020-2021):
Current Grade (2020-2021):
Enrolling School (2021-2022):
Enrolling Grade (2021-2022):
RECORDS RELEASE
Please read and sign the bottom of this form so that the enrolling school can request your child’s
records.
By signing this form, I authorize the enrolling school to request records from the current school for the
student above. I also hereby authorize the enrolling school to request records from any other previous
schools that the student above has attended. I understand that the enrolling school will not further
transfer or communicate the records to any other party or agency without my express written consent
except under authority of the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. & 1232g; 34
CFR Part 99)
ENROLLMENT CONFIRMATION
Please read and sign the bottom of this form to confirm your understanding of each statement and your
child’s enrollment for 2020-2021
• I understand that I cannot maintain enrollment at more the one school for 2021-2022 and I am
confirming my enrollment at the “Enrolling School” above.
• I understand that once this form is submitted, I will give up my space at my current school for
next school year (2021-2022) and my current school will be notified that my space may be
awarded to another family.
• I understand that if I enroll because of receiving a waitlist offer from this school that I will be
removed from the waitlist offer from this school that I will be removed from the waitlists of all
schools ranked below this school on my My School DC application
PARENT/GUARDIAN INFORMATION – This should be the same person completing this form.
Signature: _______________________________
Print Name: _________________________
Date: ___________
Capital Village Public Charter School