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HomeMy WebLinkAboutSubmittal-Community Support Part 2BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669'4390 Student's Name: M chtiel 'i ad? 2 Gender: . Male 0 Female Student's Date of Birth: 0%) Zt®l 26ND Grade Level for 2012-2013: Name of school currently attending: Lick., f 941/1(;VI Name of Parents/Guardians: 3u1ialQcU SGkkn2. Jt"\L(aeL'JctAdeZ Address: Mc /V W 1414-`- Tefr- M (©Th 1 F1 3'3 2 5 Street City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: (03 'V411 ) 1i(e sib -2A-4 Email address: j bA I I wait l s iA*11'4111 , CO "ry How did you hear about the school? mai Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: q )5 oco Name of school currently attending: On Or Via fax to: 305-669-4390 Gender: Er/Male Female Grade Level for zoiz-2013: w(t Czn-ier 1-;c &caco Name of Parents/Guardians: Er(C-Ct_ ccA L 04-1 ceR (Az Address: tat &A) hip,7 rY\ ctiv:(• ) Street City State Zip Code Horne Telephone #: an. ' 8(4;00 S3I Work Phone #: • 3G2 454 Cellular Phone #: Email address: ca... Rub?, Roact How did you hear about the school? eiocis ct4- 00.4116C tr Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson Citv Clerk BRICKELL PREPARATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 SaloStudent's Name: Gender: Male 13emale Student's Date of Birth: 12 •1 Grade Level for 2012-2013: Name of school currently attending: CO Name of Parents/Guardians: K - Ceri Erica an Lanc(2. (sz. aam: , EL 33143 Address: a 19 1/k) Le Street City State Zip Code Home Telephone #: 205' g(00 0331 Work Phone #: 34.0 I • 4514 Cellular Phone #: 7gL2 20G 9-340 Email address: En'C'Ct- • -R utc(2- aoaa,/ov How did you hear about the school? efms �H u) Ce414er cr){ 6211c.c._ Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Student's Name: VAL/INT" / t‘14 FO Student's Date of Birth: i q/200y Via fax to: 305-669-439° Gender: 0 Male Female Grade Level for 2012-2013: Name of school currently attending: 5our44 17 47-, Name of Parents/Guardians: DO F 0 2 CHI Address: 1 Afro 6°2 Hzts FL 331 5 0 Street City State Zip Code Home Telephone #: 7Qj 776 6806 Cellular Phone #: Work Phone #: 5 Afrfle Email address: D 6-t.-14/j... • C How did you hear about the school? 17--rzo-kip5 i\-fOIL/N6- Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or Student's Date of Birth: OC/ Hi 2002_ Via fax to: 305-669-4390 Gender: 11 Male Grade Level for zoiz-zo Female Name of school currently attending: cv\-4- CCAktr tTh vscuvx-N C\-Nc-oci/k-lz Name of Parents/Guardians: Address: 52._‘ -e)v4 Street Home Telephone #: Cellular Phone #:C505) 2-0 5- Email address: Ae‘>\--)e\ How did you hear about the school? Y\Ica-c,ic MC) CE 5 1.-C2— C 2_ City State Work Phone Page i of Zip' Code 3-s C-5P))------4 5 - 3 12.62_ n 0V Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: L \-2— or Via fax to: 305-669-4390 Gender: 0 Male Female Student's Date of Birth: 3.1.)1 P.. P-0 it) Grade Level for 2o12-zo13: er-3 c) LArk. 1-1e- Pnici Name of school currently attending: .1r‘e aY*0(.....?ffirL :(Y) E CC -at- -r-e/hr Name of Parents/Guardians: TS-e- Address: SO SI- D-5 c\ el\-. 20,1, L Street City State Zip Code Home Telephone #: 305 7 �5Work Phone #: 55- - 4-( Cellular Phone #: 5- - t)ci1 Email address: ,) e--(-`11 1-‘ 0 How did you hear about the school? t.)v Er:cs. Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name:10\lekiva Student's Date of Birth: LA \ \ \ OS Name of school currently attending: Name of Parents/Guardians: Address: Or Via fax to: 305-669-4390 e Gender: Male B Female Grade Level for 2012-2013: (Q01 63 t,,, ue\ \ (-A-) 5(..Ak- cz mN "VA -33 Street City State Zip Code Home Telephone #:3)99-1. (Ay, 3S Work Phone #: Cellular Phone #: Email address: 3cL(Theue-\LCY\ How did you hear about the school? \-1, G0100 • Coiryi Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 t a L)4e' Student's Name: Gender: 0 Male itI Female Grade Level for zotz-2013: 3 Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: ak-I1/41\ Address: 5\° 5 (-4-) M Mo_iln\ Street City State Zip Code Horne Telephone #:31 43 g Work Phone #: Cellular Phone #: €91?)9,•Q LLZ- Email address: bCL(Ne\kte(' - C.,r) v-v) How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: - "c 'Pt Gender: El Male Student's Date of Birth: \ Name of school currently attending: Grade Level for 2o12-2013: a Name of Parents/Guardians: —01--,\ Address: tetL-S'f-A1CD'Ve, V( A\A\ Street City State L 313) 1 Zip Code Home Telephone #: Work Phone It: 3 Cellular Phone #: Email address: How did you hear about the school? Page t of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: Rate 0 tJ kcnkacc Gender: Student's Date of Birth: e 11111 Female 24 2004 Grade Level for zotz-zo13: old Name of school currently attending: A Q Name of Parents/Guardians: IP‘Oc-Ci i VC% A k.--e Yoi\cIT-C NitCOLLACC. V069 VAUXill (Iii4CCACIA rt-L, Address: 'ACO Ve) Street City State Zip Code Horne Telephone #('''6 S 'Oc k Work Phone #: () -3-5 • .4.-4- Cellular Phone #: (-5---) 42) - 44.o 00 Email address: 1C-"G4 n I cow cc cayl ooto e oicc How did you hear about the school? 'Tr -cr\ Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth:01 Via fax to; 305-669-4390 -) Gender: DMale 11 Female Grade Level for zoiz-zo Name of school currently attending: C --Q1( k00/ Name of Parents/Guardians: C-Z_OrNOCk \\) Address: ( 52n <-,:::)(ip A cb4 \-4,ciri-S, \C )n Street City State Zip Code Horne Telephone #: Work Phone #: C4-2D15- )3 Cellular Phone #:') (0- '30) $7-- -1 Email address: IS--";)1l.),3 GC) "A C0004 c-OYYI' - 5 t J ck++. How did you hear about the school? Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson Citv Clerk DRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 5 Or Via fax to: 305-669-4390 `RocA, e Gender: 0 Male Female Student's Date of Birth: OC1 Lg - 2000 Grade Level for zo12-2013: (4e7 Name of school currently attending: M arn rt ex- 130t.orl-ccu Name of Parents/Guardians: ACt`r)01/4. Address: 2-0 CDC-L.) AS-V ce5 Ok\Cf\\ 4— Q Street City State Zip Code Home Telephone #:*7 4°--2389 45 Work Phone #: .30 C---;1 13 Cellular Phone /4:18C,- '7-3)3 5 (-;13 Email address: -3 Ivo, 03 CO - s, co a++ (pry\ How did you hear about the school? c_Ac\1-,q,c)) Page r of Submitted into the public record in connection with items PZ. 24& PZ.2S on 10-28-10 Priscilla A. Thompson Citv Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: NAT A LTA g 65 Gender: Fe a le Student's Date of Birth: 0-3 - -0 0-9- Grade Level for zo1z-zo13: Name of school currently attending: A P12:7-tM4 e A .5 A Name of Parents/Guardians: R 0 b e a izt./. m A C A 5TT LA- 0 Address: 6 izxcXfa 4-1-x03 PIM kti V Street City State Zip Code Home Telephone PP: 305- 8Sb-51).0 Work Phone # 3 - Cellular Phone #: 40 - 3)/i/ Email address: covaice,s,.NeT /c-rittoev-11)e 6 00.-ich.51-- r How did you hear about the school? 4- 2 u ) tr-se yi-A-vE A *cot-4) M4r QQL1) &112-4L,L /// D-C) b Page 1 of - 2,60? Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk DRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: 0, -e-')611/./CL '6;-, Gender: 11 Male j&Female Student's Date of Birth: ,9-S" - Grade Level for 2012-2013: 3 Name of of school currently attending: 57 /2-7, C A (A 4/ 74 Ptri Name of Parents/Guardians: c---C2-1,C,11,0 Address:-40/. U.) V? 0 A14( 1 9 Street City State Zip Code Home Telephone #:32):\"---1/6/- P28 03 Work Phone #: Cellular Phone #: SOS- S-0 Email address: )eae- CC-J-1-'1 2 V , C Ehozi How did you hear about the school? Page I oft Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636T Sunset Drive Miami, FL 33143 Student's Name: Or Via fax to: 305-669-4390 et/1 e_ Gender: Student's Date of Birth: (9 I: Name of school currently attending: 5-71 Name of Parents/Guardians: Address: ale Female Grade Level for 2012-2013: c Gf a 4( J /?PZ 1 CV 5 ? 3 479 Street City State Zip Code Home Telephone 2f10 3 Work Phone #: Cellular Phone #: ?OS- - Email address: How did you hear about the school? 1/171 COM Page r of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Or Via fax to: 305-669-4390 Gender: El Male 0 Female Grade Level for zo12-201 Name of school currently attending: 3 7 2-1/ .g? / Name of Parents/Guardians: Address: tit) Street Horne Telephone Cellular Phone #: Email address: C(1 How did you hear about the school? ef . Ae.C.14-0."1. / 2 City State Zip Code •'Work Phone #: "77 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: IviaX J3Li,vt4 Student's Date of Birth: (:)(0/ S-1 00 or Via fax to: 305-669-4390 Gender: ale [ Female Grade Level for zo12-zo13: Name of school currently attending: C ko oj Name of Parents/Guardians: ()Aar; Address: H Street , 1/1iCh-ti 812Ctci-._ Z'7r City State Zip Code Home Telephone #:,,g0S (Q-3 - atci Work Phone #: 3e 4-9g S— Cellular Phone #: 3DS 3 2 st) Email address: How did you hear about the school? 1-1(st Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one formper student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: AShiei 'au.rtfx Student's Date of Birth: 06 (IG aoc) or Via fax to: 305-669-4390 Gender: 11 Male El Female Grade Level for zoiz-zoi3: s- Name of school currently attending: C Skivi I Name of Parents/Guardians: Address:1(4, sA--tiloiscGa 09- FL. 3'2) Street City State Zip Code Home Telephone #: 105— iq 2 Work Phone i3 Cellular Phone #: ci2yDS— Email address: ree_v yvica How did you hear about the school? f)-11111 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miarni, FL 33143 Student's Name: or Via fax to; 305-669-4390 hfiA).4 4/51)00 Gender: EIMa1e E,1 Female Student's Date of Birth: Oc2- 0=2 - Grade Level for 2012-201 Name of school currently attending: Name of Parents/Guardians: /ZGY 5 C)LoIe Address: /23e ,Jib 52 .3.572 Street Home Telephone #: 78,6-- 3 i - 9) 6 2_ Work Phone #: Cellular Phone #: 305- 3 59 - 604/7 Email address: /P0,27/9 925-"? 119/), How did you hear about the school? 72 0 /9 h ne)3 City State Zip Code Page 1 of Submitted -into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Or Student's Date of Birth: Name of school currently attending: o9 Via fax to: 305-669-4390 Gender: ale Female Grade Level for zo1z-2013: 're' Name of Parents/Guardians: Ctett(4,0/ t Address: c .42,0(Dittcfr-rode. -Pi 3133 Street City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: iN 2,e I -kfo. 376 Email address: 1<k) Zt/akoocovv, o11\ am cum ele How did you hear about the school? To s Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miarni, FL 33143 Student's Name: Nk C"e n or Via fax to: 305-669-4390 6 ucl 0 Gender: 11 Male "Female Student's Date of Birth: \\\Oo Name of school currently attending: 2-t. Grade Level for 2012-2013: 1,-A e LOc\l‘eian Name of Parents/Guardians: rci Address: 16i,)5_jJ Street art\ City State -3 3 ILI Zip Code Code Home Telephone I*: 2O "D€36- LA Work Phone #: - 3 (00s- Cellular Phone p: Email address: S\LIA:lkor-r) G50, corr.. How did you hear about the school? Pece,v Cot r-\\A e Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Name of(srhreooli currently attending: Name of Parents/Guardians: "si5t1 Att. Address: Or Via fax to: 305-669-4390 Gender: 11 Male Grade Level for 2012-2013: JN?Th1P wilt( c)13 / c 1-) 77 f-VE Street City Home Telephone #: State Work Phone #: Cellular Phone #: 1 0 6 93 Email address: emale r1 3 3/ Zip Code J yg az) 6e1 How did you hear about the school? 6% - 76)5‘ Page i of x Submitted into the public record in connection with items PZ. 2/iit,.tP2.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: SCV(JV or Student's Date of Birth: 11O 24:An Via fax to: 305-669-4390 Gender: Kale 11 Female Grade Level for 2012-2013: Name of school currently attending: cry, Name of Parents/Guardians: Address: 3f,cka Street _eywi-A/ Am4 VP, # /003 '1.4(s F L -33 R/ City State Zip Code Home Telephone #: 3 D-C-510 - 9 g3 Work Phone #: Cellular Phone #: — 5(o - ,Felo Email address: tt-f5/9-1.-/t4nY\I P°L- C How did you hear about the school? 741 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: (..4,\ or Via fax to: 305-669-4390 Gender: Kale D Female Student's Date of Birth: U — 02— 7-0 or -it Grade Level for zo12-2o13: Sec) Name of school currently attending: aigi):Thc,'") Scilt-ear-V Name of Parents/Guardians: /-077 -rgle-01411./ c:::14— Mit 541-412-PM/ Address: Street Home Telephone #: Cellular Phone #: Email address: .4 /003, Al41/ F- L City State Zip Code Work Phone #: — 2cf3 - 3 C;473 Cio ggy-o / 4-70 p©t N ET — How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Student's Name: Student's Date of Birth: Olr Via fax to: 305-669-4390 Gender: ale Female Grade Level for zo1z-zo13: \-rd Name of school currently attending: v Name of Parents/Guardians: 4r \A i(lArt0 v6( CI6ivvjA kni9 Joirallo Street City Address: Home Telephone #: Cellular Phone #: '41/4 N.113 Email address: Av a Or044i66 How did you hear about the school? State Work Phone #: mai Zip Code '1°)2' Pagel of 1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's NameAhn Student's Date of Birth: Name of school currently attending: Or Via fax to: 305-669-4390 Gender: Grade Level for zotz-zot Name of Parents/Guardians: CO /1k OrOk0 Address: (19C6d CV) City State Home Telephone #: Work Phone #: Cellular Phone #: Email address: c, 33 13 CAYA6 ovono How did you hear about the school? a ei_i Female Iva 41)itr Fix .;)i-Lio Zip Code 305, tig(0J70)z d)) Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL. PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 3314.3 Student's Name: C°5i/1 (-3 or Student's Date of Birth: Name of school currently attending: /Lk) Name of Parents/Guardians: Address: 70Z '5 Street Via fax to: 305-669-4390 Gender: &Male El Female Grade Level for 2012-2013: Pit_ lc, 3 e.1-000- (-0 V--5 .43ce, City State Zip Code Home Telephone #: Work Phone #: 3 C' 3( /26 Cellular Phone #: Email address: Uct-i bc2fr-l-v How did you hear about the school? 1:5-1A,Pvfei Page I of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL. PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669'4390 Student's Name: r'OrN e-itirIOUeZ,. Gender: 0 Male Fe ale Student's Date of Birth: cl•q. e, Grade Level for zorz-zor3: f Name of school currently attending: Socri-h b1-1ffl j P-4 c-intc Name of Parents/Guardians: rrA Address: CO Pt-4C ncien z icbte s 233 15Y City State Zip Code Street Home Telephone #c3OS.15(c0--9nil.‘ Work Phone #: ?- la Cellular Phone #:(2)06) ct ers-1 - ets3-2c) Email address: t) rc.4Ide Lir) h.nc) . Ow\ How did you hear about the school? 1 on Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACA EMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or bcMACA Via fax to: 3o5-669-4390 Gender: 11 Male Female Student's Date of Birth: CA \4- (ZOLA Grade Level for zo1z-zo13: Name of school currently attending: C t Name of Parents/Guardians:T(eike-N Cp-A ry-K.1 Address: CP (C1C-0Q--\\ ND \C \ \VI ( Street Home Telephone It: Work Phone #: Cellular Phone #(--1 Email address: ..Y.V1 CCA Ccit . Cc) rn 0 c &AC) rricon'i sc40)-, Cf2D How did you hear about the school? City State Zip Code Ac, 6 \ CtAccoc) Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: VIA a-c-a-e' 2-1(1 fc Gender: Male Female Student's Date of Birth: I Z. c7cf,3 Grade Level for 2012-2013: _I ( Name of school currently attending: kr- -Scliva 1 crvi D Name of Parents/Guardians: .--17 Address: Bnc'el( iv-44-3c6? (-rill 33/ Street City State Zip Code Home Telephone #: Work Phone #: 76)5- 3 I Cellular Phone #: Email address: (") 30/7 e e _7(1G How did you hear about the school? Fo‘eviii Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 13RICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: ()Wet- Ruiz Student's Date of Birth: 529 tp.q- Or Via fax to: 305-669-4390 Gender: EKMaleIJ Female Grade Level for 2o12-2013: 5 I< Name of school currently attending: —iiarIGC) Name of Parents/Guardians: ch1 Schon\ aver and Le4V Aur2 Address: [L60 e)(1Cke.1 Bctki tJfi Otp-)-(105 , PI 3313) Street City State Zip Code Home Telephone #: 3C 14J(. —(-0-4Work Phone #: Cellular Phone #: Email address: tiB6)-210-0153(p (05)- 6 erui? Q YctIlokj laLu corn How did you hear about the school? cony toCcc_ 3533 Lruiz@Carrol i+on /or Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: eCliOVV-Ia_ Student's Date of Birth: Name of school currently attending: or Via fax to: 305-669-4390 Gender: a ie male Grade Level for zo1z-zo13: c;9-1101 CorrMhbn Sch 00 1 Name of Parents/Guardians: CIRie 55eite, IRut.i Address: II-150 Bri(eil 6a br . AO- 6205 M'1001.1 33)3) Street City State Zip Code i Home Telephone tP: 30S- glis- 1-10ottork Phone #: Cellular Phone #: 76(.0 - d‘k.)- ci530 , 3L5 - Pi'B -- 3 33 Email address: OrUl2.0_ I) \I kik) 0.On/ 1.-1 (.1 ( a.P CQ rrt911-17,)y) , ord How did you hear about the school? Page I of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636r Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: ,c Le.)14pe- 6 11 6? c9-0 Gender: Student's Date of Birth: S\ DC.XDf3 a e [2/Female Grade Level for zo1z-zo13: Kr tQ Name of school currently attending: -1-AVeui 42.1--Q Name of Parents/Guardians: / -1-te Address: PI ,r-> Street Home Telephone #: -30S -,;Q)S Cellular Phone #: 3s- L139 - cr3 Email address: -S-C-u\DIDoc €-) \A0A eflotA• COIY\ How did you hear about the school? PPce.o., 0(31 (9 eyv City State Work Phone #: 3©s S' Zip Code - Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-439° Student's Nam:24 Pnco 4/11?1(4- Gender: 'gale Female Student's Date of BirthC-"C- Grade Level for 2012-2013: Name of of school currently attending: NI /*Ter ecii-jer1-1 Name of Parents/GuardiansiS e 9A-3-3 Grt.s no Address:2-- 1 ( Mk.).3 S 7--)71A-,7; Street City State Zip Code Home Telephone g: cl C.1 9' 3 Work Phone g:) 37L-CSiS Cellular Phone Email address: TY1 V34( C-) own ; dichk eAu st-LT Y7' How did you hear about the school? (Y7 A') Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name-:-61 yth,c77,jrMR4- Gender: eale D Female Student's Date of Birth: SQZ4 )Z000 Grade1 Level for 2012-2013: Name of school currently attending: C--eSinVI.r7 Name of Parents/Guardians: Address: Street r riocii (I iC.A. 33 t City State Zip Code Home Telephone #: O3`-7 Work Phone #: 17 I 5 Cellular Phone tt: 56 S S`6Z —7,L 3 Email address: V,...)c!irtQ 7-otarnt dba-cist_ - QJ How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: 1! Via mail to: or 6361 Sunset Drive Miami, FL 33143 Student's Name: Ci?›11-0067 L.,a Student's Date of Birth: 1-i /5 0 Via fax to: 305-669-4390 nder: 1-Male Female Grade Level for 2012-2013: ZU I Li Name of school currently attending: Name of Parents/Guardians: iz3Cle,e1X0 Address: A 4,k/bpi C.L3R 4 (-cc Street City State Zip Code Home Telephone #: I \ Work Phone #: Cellular Phone #: c)'S Email address: How did you hear about the school? Page t of t Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk DRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: \ Address: Street Home Telephone #: Cellular Phone #: ons. Rtrck\lictt Email address: How did you hear about the school? Or Via fax to: 305-669-4390 Gender: ale .erna1e Grade Level for 2o12-2o13: Zip Code Work Phone #: 0J‘t-jo VJA-j 6/3 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk rcil)(ttat -fo roodjj Ahlmilf/2_ Of 20 Page 1 of BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Lt. AcricGender: Male Female Student's Date of Birth: 1OD Grade Level for zotz-zot3: or Via fax to: 305-669-4390 Name of school currently attending: Name of Parents/Guardians: Address: FAe S‘b Street City Home Telephone #: b 1 I Cellular Phone #: 1—}c5" 0 0 Email address: State Zip Code Work Phone #: _3 4 9'ciqg \\ctlfloo ory How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: Cali D IVY) GCligli Gender: Student's Date of Birth: --7/ Name of school currently attending: Name of Parents/Guardians: A Address: 3(0 SW. 7 5tme Street City ale El Female Grade Level for zoi2-zo13: Cg ckir (c-i< 03 C--,a/qr) inior)-?; FL -33/ State Zip Code Home Telephone 4;t: S33 Work Phone #: 305 31 Cellular Phone #: 77)(0- ,399 eDDG Email address: Gq Ion c)3 d q de sc_ h Do /le -7(0 (06 How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: Cue SCIE3- Gender: Male 11 Female Grade Level for 2o12-zo13: Student's Date of Birth: Name of school currently attending: COL 54,14..e.A CoA) evLg c/Pr-i-0,-)s4L- Name of Parents/Guardians: SZ.D6extxtD Address: gs-Lia 6J I Street - Street Home Telephone #: Cellular Phone g: 30S- 1--tct - Email address: k- 3 h F .33(45 City State Zip Code Work Phone #: 4.05 - - CltL01 CCIAA How How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636i Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: a)1(69OrTh ¥ Gender: E"Male 11 Female Student's Date of Birth: (42 Grade Level for 2012-2013: CA Name of school currently attending: 14V:::t-Ck' 1\-kr2---r r +V - I ki Name of Parents/Guardians: Address: _.-)L.)-1 0 Otr) RD fe,k kAA'CiAlil‘ Street City State Zip Code Home Telephone #: Work Phone : t Cellular Phone #: ....---5 COI° .C) Email address: v a't+ (ot a-01' c_u_)Kr\ How did you hear about the school? tS Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: \./ &V't or Via fax to: 305-669-4390 Gender: LI Male IcKemale Student's Date of Birth: -A 11 611 1 1 Grade Level for 2012-2013: Name of school currently attending: AoLCA $7 1tf PX(-c,1)1 Name of Parents/Guardians: VI Address: Ov-Ako 1\ika,cr4 Street City State Zip Code Home Telephone #: Work Phone #: 53 Cellular Phone ;I: Email address: 4Wf) I 00 How did you hear about the school? Page of Submitted into the public record in connection with items 1?4 PZ.25 on 10- Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: k)DCAS) Student's Date of Birth: Or Via fax to: 305-669-4390 Gender: 13/Male EJ Female Grade Level for zoiz-zo13: Name of school currently attending: (YAiUt V 010 W6( jr' Name of Parents/Guardians: Address:1 CY\ 1\N 0`-l6A Street City Home Telephone #: Cellular Phone Email address: i•ff/(6":.:214- State Zip Code Work Phone #: E (14? How did you hear about the school? Page j of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: /AN/ 1714 Gender: 0"6-a e 0 Female Student's Date of Birth: Ce(i,k/(9YerGrade Level for zo12-2o13: Name of school currently attending: 4: C72— c Name of Paren Guardians: Address: Street Home Telephone #: Work Phone #: Cellular Phone #: 7ei„ -674 Email address: How did you hear about the school? City State Zip Code Page t of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PPEPARATORV ACAUEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: /e))//4/v.17 cAs-ri Gender: Male Kmale p 6 Grade Level for zoiz-zoi3: Student's Date of Birth: t...? Name of school currently attending: /41 Name of Parents/Guardians: Address: ('4 L Street City State Zip Code Home Telephone #7/6 Work Phone #: 63 Hy( Cellular Phone 4: ?Pt .-- 444 _4-49 Email address: ey4€it Co FP P-J) How did you hear about the school? F V Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 3o5-669-4390 Miami, FL 33143 Student's Name: Student's Date of Birth: Name of school. currently attending: Name of Parents/Guardians: Address: 143 trcze No1fIct TrA( Gender: Street City ,-Male 11 Female Grade Level for zo12.-zo13: State &?-.)-)f., 3 Lict Zip Code Home Telephone #: C- (),g0 Work Phone 4: 30 eco - Cellular Phone #: Email address; S e__ Eaoly) How did you hear about the school? M rri Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson Citv Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636i Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name:Gender: Male D Female 50i, Student's Date of Birth: &3 0 Name of school currently attending: Name of Parents/Guardians: Address: \e-0.(2)\ 1l3 ()kJ Street Grade Level for zo12-2o13: 1 n M6- A&IILPAk-city \- nao arfS, L City State 33 \ 2-5 Zip Code Home Telephone ic,3k 193$ Work Phone #: Cellular Phone #: -1fl (.42 Email address: 1.)\ 0 1 @A,c,c How did you hear about the school? Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 SunsetDrive Miami, FL 33143 Student's Na e: or Via fax to: 305-669-4390 Gender: eviale Female Student's Date of Birth: // fr"--71/9 Grade Level for zoiz-2013: Name of school currently attending: 6e-ac-I<-W Name of Parents/Guardians: Address: /1"/8 Street fil,t4a2,2) cp- .11.9 aiJz, cf4.615_) 6-00 Pli_errig) City 33/3/ State Zip Code Home Telephone #-: 6-3a5)?-a0- 2.7 Work Phone #: 63° 3 Fa-. Cellular — Cellular Phone #: (PfS-) 6, -2 KS;) Email address: C fi /C2Ait7j2-KV-12) How did you hear about the school? c Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school EweMama Fenn flu MI sot ono fors for wtoiloot mod Ming lila moll to: SISI Itonsot Delos R. 33143 Ammo Via tam to: 3116-11•O-43110 Nom T ci q3 /2 Pay 1 4,12 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: 5SrfQ.i Student's Date of Birth: cf3- o Gender: Male VFemale Grade Level for 2012-2013: -7 Name of school currently attending: u\D1/4)( A-e..0^42•Ak-fAl‘i Name of Parents/Guardians: E Address: l00 ILW 22 M Kavn't Street City State Home Telephone Work Phone tr: Cellular Phone -4 Ltfl n Email address: EqEMo —1 Ln 3c- (Yi Co How did you hear about the school? S3 1 2.5 Zip Code C 0 rrTh Page I oft Submitted into the public record in connection with items PZ. 4g2L PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: ISi.a1. Gender: fl Male Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: 311 KW 15 Street Female Grade Level for zoi2-2013: City State Home Telephone #: Work Phone #: 30 5,'L3 5101 Cellular Phone #: Email address: 59 schalttogelc?1 How did you hear about the school? 00. Colt Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: Vit le Ad LI. Student's Date of Birth: 9-15-0). Name of school currently attending: Name of Parents/Guardians: Address: 3115 hi.w. (3 q. Street Gender: Female Grade Level for 2012-2013: s1‘n.97)50 1) r G at. PL g City State Zip Code Horne Telephone #: Work Phone #: Cellular Phone #: 3 S 5 )fr Email address: 5 'X 70pe yz oo • cor 3 ”3- 5101 How did you hear about the school? Ce.ceived poccard ri ie)1.1 rilta-t'rig on t - to 1-Anc Con r-4 c Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: (&te ..-( (Oak') Gender: 9 Male FemaleEr Student's Date of Birth: DI Name of school currently attending: QUO () Grade Level for zon.-2013: ( I Tr k4 Name of Parents/Guardians: LOOP-V-5 Address: IS-0 G-C) Ocic) Street io 33/(19 City State Zip Code Home Telephone #: .6)PC) 90 I I Work Phone #: Email address: Ci Cellular Phone How did you hear about the school? 1:7\ 4-0 Tyr-o\ Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson BRILKELL , T A tuition -free public charter school Enrollment Form Please MI .dons term Der student and return: Via mall to: 6361 Simset Drive Mland, FL 33143 Sbdentls Date of Birth: 0 / 31 j D-0-05 Addreez 5 k.k) (2.,_ ittit Via fax to: 305-669-4390 ADEMY 33/29 Sfreet City Stale Zip Cede Heine Telephone 67-- 3 03 Waft Phone 0: CS 00 2-8 Cellular Phone .1: (305)41(57-R3'1a Final address: 292 30 e Page 1 if 2 qiz Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Cellular Phone BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Name of school currently attending: Or Via fax to: 305-669-4390 Gender: a Male 11 Female Grade Level for zoiz-zo13: Name of Parents/Guardians: idr" fit Address: 7/0 //-a s fil(f Street City State Home Telephone q7 8---// 7 7 Work Phone : 6V6 - 5-/D Email address: 76/ e,t /Jct. How did you hear about the school? Zip Code C- 01 Page i of OQ Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Via fax to: 305-669-4390 Student's Name: Ascrii0n EKale D Female Student's Date of Birth: 0 1 — 1° - 0 1 Grade Level for zo1z-zo13: (.0 Name of school currently attending: 11-Ae-11 " Name of Parents/Guardians: k. La Evr, Street City State Zip Code Home Telephone #:30S-lo'3`--1 -S iC)S" Work Phone 4;t: Cellular Phone tt: 77( Email address: hCf-, e 6,05,D How did you hear about the school? nv I -\---z-k_7\--k 2_4 c, 7_58 Li q -1- •-• ).-\s 1\?\ ic z -- E6 y- Li Chi I h -2: I c)r- . Page of I Ce n (M) Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 0 3-05e ph \/ecj 1 & Student's Nam) Moises \ie.°, a Gender: X Male 0 Female i) Z05viel 2-0d0 Student's Date of BirthZ) 6 Feb7.006 Grade Level for zo12-2013: OC orA kA/i3 E te ,..) Name of school currently attending: 7) e yi-4- r c., iv\ a -1-e r . Name of Parents/Guardians: JOS e Mold Ve9 Address: )01 SW 9 Ave FL. 3313 0 City State Zip Code Work Phone #: 7St- S'er- 3t 6'4 Street Home Telephone #:76-c11(6-g2,5 Cellular Phone #: &:)--(1(.3- 31 6"I Email address: j 0 5 03fl How did you hear about the school? M a e k 00. c orn Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: e(z4 or Via fax to: 305-669-4390 Gender: 111 Male El/Female Grade Level for 2012-2013: Name of school currently attending: (5%004 57,4 (67' er Name of of Parents/Guardians: C rt 0 / fita_x_ Address: 3(;) /5 .s'T y 3tipz5 Street City State Zip Code Home Telephone #: Sf.4-6"2-& Work Phone #: 3r; 71"2- `747 7 76;z Cellular Phone #: S `{_3 Email address: i./0,2 13 4 iv' AJ cZ ui tk t How did you hear about the school? Page x of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 let) C,6 xKJ Student's NatW7SA JJkL Student's Date of Birth: C— or 08 Pg (9D0 Name of school currently attending:0 CArel)c‘i Via fax to: 305-669-4390 lq//1 Gender: giMale Female Grade Level for 2012-2o13:- Name of Parents/Guardians: )a)A-/- PAUL- DO trVila itlAk06A7,-Z4 Address: GO E - .AA )4m IFL, 33/.30 Street City State Zip Code Home Telephone #: (9.A5c) 761 T I Work Phone #: Cellular Phone #: (2)03-")-- 93.3 Email address: e s1J.cADA4 /root\ QM9 e How did you hear about the school? "IL) Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: ouve-Q- 446U L-C1 Gender: El Male I Female Student's Date of Birth: /9 0 Grade Level for zoiz-zoi3: Name of school currently attending: LA PIMA c-A6 A Name of Parents/Guardians: CDh41X Address: ig2L1 512.1c4tV, AV 4i ID Street ANt6th...c)/ R.Eoecc-A C Atz4e12- Horne Telephone tt: 305 qZI 98179 Cellular Phone #: 38142 205 lbesi g Email address: N.MANM City State 5312.9 Zip Code Work Phone #: AncylOCafiCrejrnallg.covn How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Namel—Gcsi r Sci)TO or Via fax to: 305-669-4390 Gender: ale P(Female Student's Date of Birth: I Co (::)(7 Grade Level for zoiz-zo Name of school currently attending: SA Name of Parents/Guardians: ke Address: 49'11 Ando keeJ Street Home Telephone Telephone Cellular Phone #: k-ef C_Orci ( Geht.,‘ City -1-.7q cl State 33fu(, Zip Code Work Phone #: CJ 1- —I Email address: r eApecc.c, How did you hear about the school? t V1 Ccu.3-\ rvk ‘.1 ec.) as-- Page I of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: -Snde Student's Date of Birth: .7 I Or Via fax to: 305-669-4390 pc LA Gender: e)c7 Q-3 Name of school currently attending: Cs) Name of Parents/Guardians: ef O Address: "Ic1\\ koNAG ee\ COM Street City ale 11 Female Grade Level for 2012-2013: Li 4 Pc CFO LA idec, State Home Telephone #: OS-1-(eiocc Work Phone #: Cellular Phone #: SOC.- Stp-- (-0`? 7c‘ Email address: : eficAeL, rev-2( •c_0 Zip Code - I How did you hear about the school? -C\N CO \P\ S: 4\vi\c 1C1c) LA) Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: M 43'414- C19060h Gender: Student's Date of Birth: 021/ 0/ 2-006 Name of school currently attending: Name of Parents/Guardians: Address: ale P(Female Grade Level for zoTz-zo13: U4 (4) Ceuk far exce.,6A, 1Zika,4-ti2 1-1 zAwrrA. Cookse 11131 Si...) 34-k S-1-1-eei+ t4aw1-1 33145* Street Horne Telephone #: 30553F-33 I Work Phone #: Cellular Phone #: ql(0-24112-'?318. Email address: r kardo capok...gors . cob, How did you hear about the school? City State Zip Code Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: r- Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Or Gotc$Dh Student's Date of Birth: 04/ 2012004 Name of school currently attending: Act, Name of Parents/Guardians: Address: 1431 SW 13H sl-re4,4-- Street City Via fax to: 305-669-4390 Gender: ale 0/Female Grade Level for 2012-2013: M ea; tt k-' c_. F-L 3 30-15' State Zip Code Home Telephone #: 3 OS- C3?-332 I Work Phone #: Cellular Phone #: q-84 - 43 I 8' Email address: r . Carao C.0* 1.‹,5orl y How did you hear about the school? adrem.+3 4- 'Fri ei".414 Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: r Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Nam5.2-c-C,\ 0.)s-KS Gender: VMaIe 11 Female Student's Date of Birth: ,/°(3 Grade Level 2012-Z013: Name of school currently attending: Name of Parents/Guardians: 1VAC\- CD13 SeVO\N\Ote_ 1Vt 3-3( Street City State Zip Code Home Telephone ;:iv(3015 Work Phone #: Cellular Phone 4305) LDL 4-49 Email address:6-V' How did you hear about the school? (36) /\-3 qS24 yricx' Coy-y\ ),c-k yroAled korre_ Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: lidie Or Via fax to: 305-669-4390 Gender: LI Male Fe Student's Date of Birth: V3- . 21. wcy Grade Level for 2012-2013: Name of school currently attending: a le Name of Parents/Guardians: EtAriue 2 I-2_0(a v‘ck i• Address: 130 SW 2,(4, Qa. it-Uaubt- 1 Street City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: 30S - zt-f (, 1 94 Email address: eH;ycJioc cc-rn How did you hear about the school? 0_ Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR!CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: EaAbella... Dic Student's Date of Birth: 01 i 2007 or Via fax to: 305-669-4390 Gender: ale 13 Female Grade Level for A1- Name of school currently attendingtk0 : Name of ceqj Address: '700 LA_) 301 (\/\ IDvn 1FL i 2 Street City State Zip Code Horne Telephone #: Work Phone #:30n' 4 ) (ocicr Cellular Phone #: q032 Email address: L ry, How did you hear about the school? Page i of i Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: 0-71 Gender: El Male 1 Female Student's Date of Birth: - 2 r.-)c 1 Grade Level for zoiz-zo13: 5 Name of school currently attending: L./ C' Name of Parents/Guardians: Address: YcLip(-6,, In S' ki 2© koct_d j- - -_331261 Street City Home Telephone #: Work Phone #: S/ y 6 it; SS Cellular Phone #: 5 2 5 Email address: 1-16-)11 leX1 How did you hear about the school? ticd d/r) State Zip Code Page I of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: „LOS 0-AL Student's Date of Birth: +:1 L Name of school currently attending: Name of Parents/Guardians: Address: Street s or Via fax to: 305-669-4390 Gender: ale LI Female II-- D7 Grade Level for zo1z-zo13: tro Wav 6,,ff fo( EvertieocC low° outt ocrir City State Home Telephone ;;t:1)‘.3 (135(1)-037C. Work Phone : Cellular Phone #:-31.) Email address: ililLieVanOCILCZ,P CyrYlOu c How did you hear about the school? Opf Zip Code 00 Page I of]. Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: MO1+0 M0141-V--1 or Via fax to: 305-669-4390 Gender: ale [I Female Student's Date of Birth: (4 .:)?) L6 Grade Level for zolz-zo13: Name of school currently attending: Name of Parents/Guardians: Epc)vo iebn, Coarvkto4voe) Address: 2-451 (V&I Ace , ate Zip Code Street City Home Telephone #: N)5 $A3 Work Phone #: Cellular Phone #: "b05 - -5U7 Email address: Catah irnOritiO C-1 (yrVil • e-Drn How did you hear about the school? Fair Cu/017 0.1\are ur 4C 'Cl2e / Page I of' Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: rru(r5Cli Gender: ale 11 Female Student's Date of Birth: 1D—C)) --D Grade Level for zo12-2013: Name of school currently attending: (f). Alfga (-.1 t--1004e5k30-1 Name of Parents/Guardians: eciovo n (1 Catil Inn La-ix Address: gi+ Jlr-cc 12-ci Street City State Zip Code Home Telephone 4#-:TD"\n""CfaD3 Work Phone #: Cellular Phone xt: 4SD17 Email address: etplainCtryt v-i\)u_11L@, 9(n1t How did you hear about the school? caao2e( Tutpt—ufige Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: bia dey ...5b Student's Date of Birth: or Name of school currently attending: Via fax to: 305-669-4390 PGender: Male Female Grade Level for zo1z-zo13: 3 rot Name of Parents/Guardians: Address: Street Home Telephone #: Work Phone #: Cellular Phone #: (4:6 Email address: - 3 '10i);1 elc (160) How did you hear about the school? )ICP./1/4_, gin mo)44? iorn; rL L3c3)-7 City State Zip Code '5) (P\.7)--.3 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-439° Student's Name: NNIEL 1rod:1m fivi4 • Gender; El Male 111 Female Student's Date of Birth: 10/ / e2.006 Grade Level for zoiz-2013: Name of school currently attending: LA CIKA lioNTESsoRi Name of Parents/Guardians: (INA ICIXEiRR ilARC.ELO A' Address: 54 0 6Rick6-LL Ri DAVE. AT i20 - rninmi -rL-35N Street City State Zip Code Home Telephone : ) 53i-6C06 Work Phone #: Cellular Phone #: ) Gtcl - 19 SL1 Email address: ANHcRisreixEifin C Y141-1 00 = Corn How did you hear about the school? ram -An om it -if MA/ . RRjcJEIL. RESIDF,NT Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28- 0 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: ilarl'ci *)et. Student's Date of Birth: 9/16/46 CrE75 Gender: Male Er Female Grade Level for zou-zo13: a-- ca kera . Name of school currently attending: Name of Parents/Guardians: kcy---1 ct Address: icaci3 g1(20 4-re Su -OE ite0( (y),, z31 Street City State Zip Code Home Telephone #: 16() (C2k Work Phone #: Cellular Phone #: e3o5-ToS 'kg.° Email address: PI GO T7 - r)'r (31 • How did you hear about the school? /3/1, Page i of • Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: cifYi t 6_ Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: V3k1:7D Street Gender: Male male zoo 9 Grade Level for zo1z-zo13: LI T31 rkek.e.lcve-ka__ e.,KeA tnej cAc.ak Pt-1 c vo La' 2_ City State Zip Code Home Telephone At: Work Phone #: Cellular Phone #: -440 413 C., Lti Email address: 01012-AcQq6.. CO4 002E2_ to 6. lolloo • Loni How did you hear about the school? Me Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PPEPARATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: -170•5--) Or Via fax to: 305-669-4390 4) Gender: Student's Date of Birth: tb /6j Z-00 g 'ale 1 Female Grade Level for zoiz-zoT : - Name Name of school currently attending: tst VI (1\10 Isk% Name of Parents/Guardians: i\-tclkg--1 00\4_ k A ‘ckk5 6,2364,ext PickL i1/4-k1,64--kk L Address: Street City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: el--23 6 Email address: • ca\)c.v_e,?- E YovVioo • cini1/1 How did you hear about the school? [DI a.-INcCekk L Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 KStudent's Name: rumba' Student's Date of Birth: io/q/iqq7 ender: 0/1\r/tale [I Female Grade Level for z01z-zo13: Name of school currently attending: hi ak Air ddl Name of Parents/Guardians: Address: 6c)wrno_kfl NW /0 --)ireel- tviary)1, Ft 33!_3(0 Street City State Zip Code Home Telephone #: Cellular Phone #: /781.350 Email address: GC-- I _1 Work Phone #: How did you hear about the school? Flyer n au a.' Givvi---g_Ao Page I of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACAC EM A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or Via fax to: 305-669-4390 R© rl 0.n1 S k Ka` Gender: , Male 0 Female Student's Date of Birth: 0 9 — ° 2- 20 0-S"-- Grade Level for z01z-zo13: Name of school currently attending: 1" riort CoLsA Mart a�i Sc�oc Name of Parents/Guardians: Nottry\rato. l\ajesk gl( Address: 2 222 B„-ri' ke Avp- Art-‘ • i`Uclf' t- 2-9 Street City State Zip Code Home Telephone #:30S— 8 tAL —9 S 2 l Work Phone #: Cellular Phone #: Cak.)— 71 C —0 6 33 Email address: ':'l &h'l7 O-sl f-ks? " crYn How did you hear about the school? Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: R._ A3 IT -C( Gender: laMale 11 Female Student's Date of Birth: ) 10 161 9 4- Grade Level for zoiz-zoi3:9 Name of school currently attending: ga„,,,L.,, di t.,:cta1, Name of Parents/Guardians: \\%\ VVVr Address: 2-1 gykcKe,ti, L 332_ Street City State Horne Telephone #: 305-- g Li 6 —1C IThWork Phone #: Cellular Phone #: 6 6 - Email address:2'1 ckVrx-y047.- C_Ltv-r1 How did you hear about the school? Zip Code Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: or Via fax to: 305-669-4390 IS \ ZCO2_ Gender: El Male XFernale Grade Level for 2012-2013: Name of school currently attending: Lb- GrAtn cdv, Name of Parents/Guardians: Address: s ‘A_ Street Home Telephone #: Cellular Phone #: Email address: anise, 2,03 iLtA City State ci S-2- Work Phone #: 3C)S - - (fic2 c\o,a_se bLrofy, 60r0--ac How did you hear about the school? FL 3 3 \ Zip Code 3 - 3(s-Lia2 c=/' 1,c,4e,( c t (Lie Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: gcc,ei Gender: (f) 6 c Student's Date of Birth: I 1I 00--?-- Je(N,k Name of of school currently attending: 11 Male Female Grade Level for zotz-zoi3: -T"'"ir,St"ricL /cetcle0A.i Name of Parents/Guardians: IIMMC-•° Cd (6 2a-4 \it \i(6-Ac, t--9 CA--• Address: f\) 2)71+ Ltik-i ?D(SC Street City Cle ate Horne Telephone #: 3' • S - Work Phone #: Cellular Phone #: 30 S CID 3 Email address: V Oil 6(-)6k, • -a. 3 3k6 Zip Code 30S- 3‘,,S--\41-1S-3 en4qC-6-Y4R-TA LatvA How did you hear about the school? Pas cc& aj IV\ cr_o_ cc, cku 6-u\--s[A-10 LSit\ ttottS 4;),,r Page i of 1. Cw 5-1..t.r Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: j or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: HiA OCire5 Gender: Male Fil<ma e Student's Date of Birth: 2(- 2_DOLO Grade Level for 2o12-2o13: Name of school currently attending: Name of Parents/Guardians: Address: i1rw`3 rnustAir -pao1a_ uuvares rniam pi-- 3337 Street City State Zip Code Home Telephone #: (7)5)3Lp-8( 21?Work Phone #: Cellular Phone #: Email address: 171A°L-11 OLiVA-S G- rr\CA Qiorr) How did you hear about the school? f\-iatttnG-- --1" 54- COED Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: rn GOneW 01 WSG„der: Student's Date of Birth: (10 a3- (00c1 Fr(lale 1 Female Grade Level for 2012-20 3 Name of school currently attending: Name of Parents/Guardians: tn‘Q qt‘db 4s miam. ft__ Stree City State Zip Code Home Telephone 305)3k0-'89 Work Phone #: Cellular Phone #: Email address: How did you hear about the school? TO)-Y-CD(d .1(\ r\ilo, Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Na e: tek qe2C. CIUJAQtaGender:Ikiii 11 Female Student's Date of Birth: APel\ 1(3 2001 Grade Level for 2012-2.013: Name of school currently attending:53140-ethi G4Ne. Name of Parents/Guardians: KPaS K11:: Address: 2J2 i2.Qj Mi ity Street Home Telephone #: Work Phone 4t: Cellular Phone #: Email address: address: Kt-tygsciAc.1)(m+2GmFA.cipt-i How did you hear about the school? 33133 State Zip Code Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson Citv Clerk Cellular Phone : BRICKELL PREPARATORY ACA A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: ,sa, Student's Date of Birth: fD Name of school currently attending: Name of Parents/Guardians: Address: \ley-)ko, Gender: Male II/Female Grade Level for 2,012-2(313: K ly ,„q+1*- POckci (Mani ?.D)c29-1 Street City State Zip Code Home Telephone #: 858 Cap Work Phone #: 305 6758 cd 2 3C8 (ill Email address: COX\ cary, How did you hear about the school? --1kg645frli ryia.‘(A, Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORYA A-E Y A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Student's Via mail to: 6361 Sunset Drive Miami, FL 33143 or Name:Ca )ROLC34—iCk Student's Date of Birth: 3tOia;1 22, Name of school currently attending: Name of Parents/Guardians: 16CYY1 Address: Via fax to: 305-669-4390 Gender: F' Male LI Female Grade Level for zo12-.2013: 2 N enk_o 1,T2b_,•mcD1A-c-6 \k).D.cl-Eirki AAIon .aik 1, _3 1 71 Street City State 2gip Code Horne Telephone #: 305 SSE a/9 Work Phone #: 8..SS 0 S 2A Cellular Phone # : '305 9 c)zy ) 3 Email address: Kiu g i cu.( 6thirnGui.„ 4 CT How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson Citv Clerk BR1CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: le_ Via fax to: 305-669-4390 SChitA18-2. Gender: Male Vernale Student's Date of Birth: RP I 8, 2005 Grade Level for zo12-zo13: 2NCA Name of school currently attending: Sol -terse+ Ac1€5 Name of Parents/Guardians: KARSN t1/4)15. Address: 2c3CC) V-NI Skae.:4- 1-4IA1-1 Street City State 133 Zip Code Home Telephone #: Work Phone #: Cellular Phone #: 3cD6 3c102- mysizsSC11UJINIkt2-e, GHAT 1- CO H Email address: How did you hear about the school? Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: 2 or Via fax to: 305-669-4390 Gender: Male 'Female Grade Level for zo12-zoi3: Name of school currently attending: 5T. 1-1A1T/1 0 11; e e Name of Parents/Guardians: , 250 1,ju,) 7_2,3 12 5 Address: 4N-/1, 6, vi't , r (-- Street City State Zip Code Home Telephone it: 305-5'1 (- © 5 I -. Work Phone tt: Cellular Phone #: 2.2-1t1 Email address:R , (14. ,(_ Co How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 61l A1AJ4 6)C1.t4C(iA or Student's Date of Birth: O (3 ) ?CO-3 Via fax to: 305-669-4390 Gender: 11 Male g Female Grade Level for wiz-2013: 1-4- Name of school currently attending: k()Ac ME ,Q1 1-11' Name of Parents/Guardians: IC��1�,L �' LOU 2D.E5 (-4/.1‘SNC1 Address: 1 50 5 W 2 (2.0 kNt (iki►k(� Street City State Zip Code Home Telephone #:30j6 FS6o (k Work Phone #: C21 (( Cellular Phone #: 3 - 30Z- (02.5 Email address: U €)Qbi\cC(i4,4 BE(LSOUT1. r� � How did you hear about the school? Page 1 of 1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Na e: or Via fax to: 305-669-4390 EL. Gender: Student's Date of Birth: te J IL. 0 (6" ale 1111 Female Grade Level for 2012-zo13: Name of school currently attending: 11-q_K) IOW MIKA 04-k 44 Name of Parents/Guardians: KJi LOJQOE_ S C-1 tkC Of--) Address: I SO Street 5„u Z914 QRliULA City State Horne Telephone #: 30V&b0 CIO Cellular Phone #: -Gasi Zip Code Work Phone #: Email address: WC-44,-CL S011-1-1, it1t1 How did you hear about the school? --/-(-{,ft k) --(Y0L7 -T AN5E. Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or Via fax to: 305-669-4390 faC:e, Gender: Student's Date of Birth: C/— 0.7 /— 0(7 Grade Level for 2o12-zo13: Name of school currently attending: X A /1-6 /(/--/ I) -4Lz 6c,ces Name of Parents/Guardians: / le_ MS ,& CO iCt'et Address: /571 d It/b c?„?; , 35/d 42, Street City State Zip Code Home Telephone PP() - 7 I Work Phone #: 32Z—a.5 Cellular Phone #: 36c- -.2,-7/36 Email address: J&9/Cf(.); How did did you hear about the school? 04?-) Pyr77 Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Cellular Phone tr: Email address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: 1 fe_. Gender: Student's Date of Birth: 1:"5 ('r) DI Name of school currently attending: Name of Parents/Guardians: Address: Male Grade Level for 2012-20 e 23D1 .5. ) au' f-Inrir-zr;(7 Street City State Zip Code Home Telephone #: Work Phone #: /3D s How did you hear about the school? t.GOAce c)-6 (YrpZi-c-c-14,- Page t of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: 9 1 Name of school currently attending: Name of Parents/Guardians: or Via fax to: 305-669-4390 Gender: LI Female Grade Level for 2012-zo Peite-6 cCP „LA_ Preb sVcp('h'n_pq.-- Address: 2_3 ( Street Home Telephone 4: cA---, z__33/f City State Zip Code Work Phone 4: Cellular Phone 4: Gn —I k7 Email address: (4--CA C _)(1 e How did you hear about t school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28- 0 Priscilla A. Thompson City Clerk Address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Na e: nder: Eli Male ff.-Female Grade Level for zo12-2,013: Student's Date of Birth: ti \ 12.— I C Name of school currently attending: ct Name of Parents/Guardians: yAria Pco mum, Street City State Zip Code Horne Telephone #::3/-7— 14 2 9 ZCZVork Phone tt: Cellular Phone Email address: How did you hear about the school? g coa-ct,y+ • rv2_t (--)110.4.z2c9 Page i of I Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICK ELL PREPA. ATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: r0 (Ad6n Student's Date of Birth: 12—/7/200 Grade Level for 2012-2013: Or Via fax to: 305-669-4390 Gender: LI Male [114emale Name of school currently attending: Name of Parents/Guardians: Address: 2..."7 W Street Home Telephone #: Cellular Phone #: Email address: City State 7.-owirnan m3°1111 Ft- -51(47/Apt3CC Zip Code Work Phone tt: 7S350 GTTVLLI u_mgC0/1- Lam How did you hear about the school? r----Iy-or +h.( mot Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: or Via fax to: 305-669-4390 n Gender: U‘ale 11 Fernale Grade Level for zo12-2o13: Name of school currently attending: Name of Parents/Guardians: Address: [7_3 Street \yv orypi City State Zip Code Horne Telephone 4*: Work Phone #: Cellular Phone Email address: How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: K 1-010 f C;aS\-Co or Student's Date of Birth: 01 - 2:ES - 2C) 3 Via fax to: 305-669-4390 Gender: 0 Male XFemale Grade Level for zolz-zo13: Name of school currently attending: • '�l Name of Parents/Guardians: C� eS . Address: a 8 9 \' , C'• ti-.kk na--1/4:\ — '-�... 3`3 V2J Street City State Zip Code Home Telephone #: �14 Cellular Phone #C8() /a/ 'l -\ Email address: C°A�Oy C'�f� �C'7 Y4- \ How did you hear about the school? Work Phone #:(C ) S 16 ^ \83� .7 \it--) Page 1 of 1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's NameS C.1 Gender: Student's Date of Birth. 1-130 Name of school currently attending: Name of Parents/Guardians: Address: Grade Level for zolz-zo Lcd— Yt-f2 C CA/ 0--OCIN) (rtf\k-i? L 33135 3 -S Street City State Zip Code Home Telephone #i--a)S 7 1_Work Phone #: Cellular Phone #: Email address: 3L-r-rISL_ NI yr\ How did you hear about the school? QDJcVI 0. (07)-- Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Address: BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: or Via fax to: 305-669-4390 Gender: ile LI Female Grade Level for zoiz-zoi : Name of school currently attending: 4. c \t't vl Name of Parents/Guardians: \ 01\ c-r eC.S -VC e{) (Z4 v J"" 1-(AkQ 33c)S Street City Home Telephone Cellular Phone #: Email address: L30C Stafie Work Phone #: Zip Code 33 \ 33 ()DO 2 / irr)0-:6r-i • c) \ic--(111i0 How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: or L Via fax to: 305-669-4390 Gender: 11 Male emale Grade Level for 2o12-2o13: Name of school currently attending: i4Ck) IS2.111... ame of Parents/Guardians: s Dtli( 100- 0- dress: -3-3 tR.CDULj CUo& %on3-6 (r-vi fx.Q/ . -33) 3 State Zip Code Street City Horne Telephone #: / Work Phone #: Cellular Phone I*: As) --3pp --01 s5 Email address: 6 cA 4-1 00. How did you hear abou the school? fas ,44 cesolk4 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Na Student's Date of Birth: Name of school currently attending: 11 or Via 30fax 5_ 6a69.to . 43:90 Gender: Female Grade Level for 2,012-zot3: Name of Paren s Guardians: b)-Y1r L 5 Street Home Telephone #: (:)-Kt) EYS3?Vork Phone ;±: Cellular Phone #: Email address: E How did you hear aboijt the school? City State 611/141 Ft- -3,3133 Zip Code 30 -0/6-3 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: 05- 4 Name of school currently attending: or Via fax to: 305-669-4390 Gender: Male 1111 Female Grade Level for zorz-zo13: Name of Parents/Guardians: 13bia Pa cCi1. Address: 3as S. rke ISV.141/4 • -4 ZA-Ict av L 33131 Street City State Zip Code Horne Telephone #: 3CT 34-31-S" (13 Work Phone #: 'Sac- 31-3 3 TS- Cellular Phone #: Email address: 50C 310 s'9(09 How did you hear about the school? .t. t Liaz r Page 1 of L. Com Submitted into the public record in connection with items 127d48 PZ.25 on 10- 0 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: r Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: Gender: liKrale11 Female Student's Date of Birth: 7 - 25 2005 Grade Level for zo1z-2o13: 2 Name of school currently attending: Name of Parents/Guardians: eaSa. vaia a 1,1 o 4,4 e Address: ()Li c I 6Ki'CKet t Street fess° ck_YSAS , tx Ni 1/1 k 6'1/ C 33/c)7 City State Zip Code Home Telephone #: 505" 3q 5-3L2 D Work Phone #: g(o Cellular Phone 4: 3i-f 7- 22-1 cb Email address: 50-(CArn0 r\ "1—C How did you hear about the school? ev\A iY1 al 1 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 44( or Via fax to: 305-669-4390 Student's Date of Birth: Name of school currently attending: ender: g Male [i Female Grade Level for 2012-20 Name of Parents/Guardians: SE.4,8A, do r Address: S '2 tef rea; 4/, 4 Street /V' ;• 'State Zip Code y Home Telephone #: , - 7 ?:7---Seie7Work Phone #; C 2 z Cellular Phone #: Email address: 2,32 z226, 60/,3'c 2?V How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 1a/13/2011J 22:36 30522728Ei7 MODERN BANK PAGE 01 BRICKELL PPEPARATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 3o5-669-4390 Student's Name: 7310 6)14 UPi Gender: Male IKe'male Student's Date of Birth: 31-c)D03 d _ra_e __eve_ _or 2m2-2o Name of school currently attending: Name of Parents/Guardians: Address; \W 3k.) Street City io rn) State Zip Code Home Telephone .4:—"D E.56.1 C) Di) Work Phone #:1 Cellular."Phone tt: 5 -701 8- Email address: How did you heat about the school? jErs (1-r) tillsn Page 1 of Submitted into the public record in connection with items 15.,2118---, PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Hm did you how about the schooP. J-- ' �� ��}(v ^A � Submitted into the public record inconnection with items on -----=` Priscilla A.Thompson CitvC/erk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 or Vla fax to: 305-669-4390 Student's Name: c eVl \'a"a' Gender: Male Female�� Grade Level for 2012-2013: Student's Date of Birth: -1U 042- \ C) a O Q `1 N ame of school currently attending: N ame of Parents/Guardians: 1),; `J .2ea 1-lore-- Address: T3 o Street Home Telephone #:� @ o,(a\ wz rlori 33 i %- City Hti \ao..LState L Zip Code 371 y 'l- 903 Work Phone#: (3os) &1�-\`Ec� Cellular Phone #:( '? ( ) L l - (► a 3 Email address: (Of \\,O,\ mom,\ • QO(al Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/13/2010 22:36 3052272827 MODERN BANK PAGE 02 BR CKELL, PREPARATORY ACA DEM A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 3343 Via fax to: 305-669-4390 Student's Name: 631./i/ itttl bf (Dio0.4 Gender: 0 Male Female Student's Date of Birth: 01 - 1 - v 0 0 Grade Level for 2o12.-zot3: (Name of school currently attending: Name of Parents/Guardians: Address: Street Horne Telephone #: CellularPhone : Email address: How did you hear about the school? City State Work Phone Pt: Zip Co Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/13/2010 22:36 3052272887 tyliDDERN BANK PAGE 03 BR. CKELL PREPARATORY ACADEMY A tuition -free public charter school Please fill out one for Via mail to: 6361 Sunset Drive Miami, FL 33143 11 Enrollment Form and return: Student's Date of Birrh Name of school currently attending: Horne Telephone 4: CellularRhon.e Email address: -)/ How did you hear about the school? Gender: la4ale 11 Female Grade Level for zotz-zo13: Work Phone #: Pagel of p Lk-ftrpoi-1) Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 305 01:30:04 p.m. 10-20-2010 2 / 2 r ‘, t) How dld you hear about the school? L e'je s--% R tA 42 Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR. CKELL. PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: bcc Student's Date of Birth: or Via fax to: 305-669-4390 CAtIO Gender: 1141e 0 Female t)01.4 Grade Level for zotz-zoi3; af Name of school currently attending: 0\O of F;-einflPA-611y Name of Parents/Guardians: Address: \--0\ Street \ACA T4tAA DS./C t'Actca L 33V2-5 City State Zip Code Home Telephone #;-3.05- 3\ -19 3 Work Phone #: Cellular Phone Email address; r-\olgLr How did you hear about the school? L4 0Q61,, cA Li-t( Page iof1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ZO/Z0 39Vd TEZOLEV982. Lt7:Z OTOZ.'ET/ 2010-10-19 07;50 » 3056694390 P 1/2 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out one form Dor student sod return: Via mall to: 63$1 Sunset Drive Miami, FL 33143 or Via fax to: 306-660-4390 Student's Name: 6:7- /OWN() iYOffl$t7, bcc_ Gender: 6:11211 Female Student's Date of Birth: /00-7114Sot., (;).17?-1,:iltet)Grade Level for 2012-2013: me of school currently attending: mus6--gni Address: /NJ. / I s--r--rece7— fLrixr/LiE.: / Street City State lip Code Homo Telephone #: 3'19 07 Walt Phone n:30S _3 a<, oq 16) Li?-qr7o hiter Phase 6: 305 W- ° -71c3c. 3 Email address: MCP a ho-rircIA‹t_ cc m Pagel of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 2010-10-19 07;50 » 3056694390 P 2/2 Now did you hear about the school? i rPY1 of c DF ��n s00`s Cw'-1ssfA1E-s R CEzuco T� C-t kin it-3 F\& rr iI S S' e ( `- (Sum op \kS CON COuvEn fULic.1 (� �10 WE LOA 1 S na. DU.R CC�.D1 5 Tu_s 2- ti fn (,) 90 s LA() TO b.)UPPc -NE bocoNTO JD pe-A Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk m : BBI Florida To:Brickell Prep (13056694390) 13:39 10119/10GMT-04 Pg 01-02 A tuition -free public charter school Enrollment Form Please fill out ona former studentandjiturn: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: Street Home Telephone #: Cellular Phone #: , Email address: or Via fax to: 305-669-4390 L. Gender: Male (\Female, Grade Level for 2012-2013: 1410* City State Zip Code Work Phone #: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Now did you hear about the school? Page 2 of 2 submitted into the public record inconnection with items PZ'24&&PZ.2Smn 10-28'18 Priscilla A.Thompson City Clerk 305 646 7056 01:18:16 p.m. 10-19-2010 1 /1 BR1CKELL PREPARATORY ACAOEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: Gender: Male Female Student's Date of Birth: Grade Level for 2o12.-2013: t I Name og,schoolicurrently attending: Name of Parents/Guardians: Address: Street Home Telephone Cellular Phone #: Email address: I / „ './r/. How did you hear about the school? Work Phone #: /41 )./ CJN Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Page of [ / 1'/>- / -/ [:C,T-19-2010 13:10 P.0'2 04 eRIC ELL PREPARATORY` ACACEMY A tuition -free public charter school Enrollment Form Please MI out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name:/a./9-0/4/ Student's Date of Birth: 47/Zg 9.5-- Name of school cuyently attending; Female Grade Level for 2012-2013: / / , Name of Parents/Guardians: address: /a E .7 xlsr- mil, M fL 9,JY? Street City State Zip Code Home Telephone #: Work Phone #: qfz/._ T7 6ZJ j4 Phone #: a 41 Pane "i of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk OCT-19-2010 13 : 1 0 4 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fin out one form Der student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 4/1-1-6- L2---+�L *+G�'�+ /41 Gender: Male Female Student's Date of Birth: Grade Level for 2012-2013: g Via fax to: 305-669-4390 Name of school currently a d Nam. of Parents/Guardians: vv477-i. ,v pC �sisr©. /tL� ' ZT Address:42I Street City State Zip Code None Telephone #: Work Phone #: �✓ 7 ��� P 09Z Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk OUT -15-2O10 13:10 P.04�1-04 How�� you hear about the school? vorl ' Page 2 of 2 Submitted into the public record imconnection with items PZ.24Q^P2.25on 10'28'10 Priscilla /k.Thompson City Clerk TOTAL P.04 OCT-18-2010 10113 P.001/002 BR1CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and rettirn Via mail to: 6361 Sunset Drive Miami, FL 33143 I j Student's Na e: Student's Date of Birth Name of school currently attending: Name of Parents/Guarchaps: 1\3 Address; MO Street Horne Telephone #: or Via fax to: 305-669-4390 ao Gender; 0 MalwlErFernale 2, 0 Grade Level for 2o12-zo13: z434- City State Zip Code 34eDWork Phone Iv c1C), \S Cellularn Pho e It;ClaS. Email address: 1M CZ j3 (- C How did you hear about tile school? Submitted into the public Page i of record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk OCT-18-2010 10:18 F.002/002 Address; Home Telephon Cellular Phone Email address: BPiCKELL PREPARATORY ACABEIYIY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Na Student's Date of Birt Name of school currently attending: or Via fax to: 305-669-4390 Gender: Ma1e 0 Female Grade Level for 2012-2013: SC2-1) Name of Parents/Guardiains: 3Ck0 k ,0 CZ()° a\ch \k-Voil\&.1k Street City State Zip Code (05 1V6Vork Phone 1:p: V316 C) How did yoa hear about the school? Page i of I Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk TOTAL P.002 10/19/2010 09:11 3054473920 GEM TECHNOLOGY PAGE 01/01 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one forrrA per student and return: Via mAil to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: Toseba A. Maruri Gender: X Male 9 Female Student's Date of Birth: o8L26/o03 Grade Level for zo12-2o13: 4th Name of school currently attending: Coral Way_llementary Name of Parents/Guardians: Anthony Maruri,a Address: 45 SW 22rid Road Street Horne Telephone a: 3o5-8_5§-8173Work Phone a: 305-609-ii7o Cellular Phone a: 3o5-609-nz9__ Etnail address: arnaturiageti c,org Florida How did you hear about the school? Meeting at the ConradQn OctoIt 16th City State Zip Code Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/14/2010 18:03 3052272887 MODERN BANK PAGE 01/01 BRJCKELI PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one forrn per student and return; Via mail to: 6361 Sunset' Drive miatrii, FL 33143 Student's Name: g Student's Date of Birth: i/ kV iS) 11 Name of school currently attendin.g: Name of Parents/Guardians: Address: IL -I a Street Home Telephone *: Cellular Phone 4: 63c ) 8 Email address: How did you hear about the school? or City Via fax to: 305-669-4390 Gender: a1e El Female Grade Level for 201z-zo13: cP State Zip Code Work Phone 4: 06S-) Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/19/2010 10:12 3058582272 PAGE 01 '; ';;;; ; • ' -1:- A tuttlon-free public charter school • Earollmont Form Please MI out ono form per thoilipt seld retinal Via mall to: 8361 Smoot Dries Miami, FL33143 studios Nam SARI SCHECHTMAN swears Nate or gazu 12/26/1 £+95 Name at school aally atteodlow MIAMI HIGH SENIOR Name at Parents/Gaanlhum DAVID SCHECHTMAN Via fax to: 305-812-4380 Grade LAW ter 2012-2013: 11th Address: 1460 SW 7 STREET IAMI FL 33135 ci Rama Telephone 305-854 3283 305-858-5475 mow moue 0 305-970-9800 Email address: davyrniami a ($$$ Wark Phone lk TM Cede Now dld you Mar about the school? Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/19/2010 10:12 3058582272 PAGE A tuition -tree public charter school Enrollment Form Pine, fill out ono form nor stallmet and rotors: Vi. mall to: 11341 Sunset Drive Mood, FL 33143 slimes Nom: PHILIP SCHECHTMAN Studactra Data 01 BRIM 1/06/1998 Name of ticked currently attending; G.W. CARVER MIDDLE hams of Porenb/Goorilleas: DAVID SCHECHTMAN Address: 1460 SW 7 STREET er Ma fax to: 303-11811-4300 Grade Lord for 2012-2013: 9th MIAMI FL 33135 Strout None Telephone 0; 305-854-3283 305-858-5475 Cellular Moos ilk 305-970-9800 address: dayyrnlami@sol.com Hew did pa hear shout the salami? postcard mailer Citys 7,10 Code Work Wow 1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/19/2010 10:12 3i5CE2272 PAGE 03 A tuItion-fraa public charter school Enrollment Porn. Please MI out one form Der student and return; Ma moil to: 6361 Sunset Mee Miomi, R.33143 midwife Noma EVA SCHECHTMAN Shekel% Data of MAW 1/06/1998 Name of ached eerundly ate COCONUT GROVE ELEMENTARY Via fax to: 3115-81111-43/10 Grids Level tier 2012-2013: 2nd lame of Parsub/Guardlemo DAVID SCHECHTMAN Addrew 1460 SW 7 STREET MIAMI FL 33135 Shod Nome Telephone ih 305-854-3283 305-858-5475 &now phone #: 305-970-9800 Email oddly= davymiami@aol.com How did you Item about So school? postcard mailer City Zip Cole Work Phone 0: Aye / Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 19 2010 8:47AM LAW OFFICES (3051 577-0282 p.1 8R C ELL PPEPAPATORV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form Der strident and retire: Via mall to: 6361 Sunset Drive Mlaml, R. 33143 Student's Name: Student's Date of Birth: or tact-( Name of school cunentl endiLng: Inc-�;�,.4 eNSARi 1 �C-. < `- AddreS?ss:n Street Home Telephone #: Via fax to: 305-669-4390 der Female Grade Level for 2012-2013: Vr '1 (G2 {c•,vs: City State Zip Code ) 33 y ` 0 5 6 Work Phone #: (3 c ,s� S 1CC Cellular Phone #: Email address: Sc SC Cava (�( 3 ( C (P) b t n_ o/.(a C C, e , � t C S�v�s e u�ye "21- Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 19 2010 8:47AM LAW OFFICES (305) 577-0282 p.2 How dkf you hear about the school? Pr-e. (") ifyit c, cr&frS-ti cL 6 nkca L1 s-c4 Page 2 of 2 11-1-ecj 4.\JLIL S Submitted into the public record in connection with items PZ. 24& PZ.25 on 1028-10 Priscilla A. Thompson City Clerk Oct 19 2010 8:47RM LAW OFFICES (305) 577-0282 p . 3 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall le: 6361 Sunset Drive Miami, FL 33143 i , Student's Name: A1 -c ( cat/c- or Via fax to: 305-669-4390 Gender: Male Student's Date of Birth: 0 c\ `1. Grade Level far 2012-2013: whoal rumen iittend194: A A Li, 4•15.,-,0( 544. gc" Si Nme of Parents/ tiardians: 11-1tv-ic dress: DA F- (( Street Homo Telephone 4:(3 6 6 Work Phone #:( )5,-? 4 Cellular Phone 01 Qes) Y5 ( - t Emailadd ecr) ;, Sc'cc P4( 4 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk City Slate Zip Code Page 1 of 2 Oct 19 2010 8:470M LAW OFFICES (3051 577-0282 p.4 How did vau hear about the Ae Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/19/ 2010 08: 07 3058171910 TEF PAGE 01/02 ckcAL PREPARATo y AcABErty A tuition -free public charter school Enrollment Form Please fil oat ens form our student and return: v:a wall to: 6361 Smoot Dd Miend Fl. 33143 Student's Student's Date of /Artie 2001 Vla fax ts: 305-6611-43110 Grade Levet for 2012-X113; 6 1 rA 0 e Name of school currently Mending: MLrMeNtidren lvtuseurn tiAR le 12 school Menu of Pareets/Goondlans JLIA B. ritArziN Address; 10.2,9.10/1. kAFrk MIAMI Fi 33(26 Street City State Zip Coda HOMO Telephone (13 05) 0 g 2 G We* Phone a: (130.5) 8883528 Cellular Phone a: C605) cliolzG Email address E Quuz071-5 CO) lAo-t malk co of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10719/2010 08: 07 3058871910 TEF PAGE 02/02 Page 2.12 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out ono form.por st�dsnt and return: Via mall to: 6361 Sunset Drive Miomi 11.33143 Stndent's N or Via fax to: 306-669-4390 NG- Lz Gender: Male Student's Date of UM: 01 1.22-7 id-004 Name of school currently attending: S-t. rAlcuitzi_ Name of Pare 4-1 Address: Nome Telepho .Wo City Cellular Phone m 30 c Page 1 of 2 Grade Level for 2012-2013: 4- OLI 4 Zip Cod Code It: 30s- Ssic — 45 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-2840 Priscilla A. Thompson City Clerk 10/19/2010 TUE 7:40 FAX 3054776371 AdvAdmin Area 0001/001 BRICKELL :PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name:0 I CiR Pain Student's Date of Birth: 3 la a00-7 Name of school currently attending: or Via fax to: 305-669-4390 Gender: 0 Male Female Grade Level for zolz-ao13: vgA/a/tiOrx)/ Name of Parents/Guardians: [(5/1l _ )i9 ie4190.5-0/ 011 efiii7 Address: (Q0 aprixal Piarni iZ63 i37 Street City State Zip Code Home Telephone #3CS-S—KO-Lt/C/07) Work Phone #:3 OS' Cellular Phone #: OS- aq 1 S Email address: 0--Waie 0 50 ehoiloa i com How did you hear about the school? Ptowethsetnem-f-- Trio' Page i of I Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk V \c LOC; v BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student aad return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Student's Name: 4- Via fax to: 305-669-4390 Student's Date of Birth: Street Home Telephone #: -30S Cellular Phone If: aas-- 3© City Email address: , ___14.c-kdehlie Gender:Mal Grade Level for 2012-2013: Page 1 of 2 State one #: hip Code 024Z-5 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk r OLOCY s 5 etz„, goZ How did you hear about the school? eel Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk --2k11 id 16: 22 EFL TPL 17F-F4a.:'.R2FIFI F. 01/02 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form Der student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Vla fax to: 305-669-4390 , Student's Name: C/C1- ‘/Lof - M Ar Gender Male Student's Date of Birth: .Z SO 2 0 0(P Grade Level for 2012-2013: Name of school currently attending: -net" Welk &pi\ ktaiti)-- Name of Parents/Guardlans: Robk )-0 4 ieoe &sta.ta_ Address: Pe_ccal s-F 3,33 Street City State Zip Cede Nome Telephone #: 305- 4444 -114 Work Phone #: 305 - AN -ant Cellular Phone #: 86, • Email address: hl-Ck 60.okcAck. ce) Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ncT -2n10 16:22 EFG CHPITAL 1=UF.4',2Z620f1 P.1712.'02 Now dld yea hear about the school? TRA-Lij -a-yarj - Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Page 2 of 2 TOTAL P.02 OLT-21-E010(THLI) 1 : MT' NETWAPF,S LATIN HMERICH P. OB1/002 BRICKELL PREPARATORY ACADEMY A tultlon-free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Via fax to: 305-069-4390 Student's Nam 1•A‘nhatt itc• Ac\volt2-• Gender Student's Date of DIM: C531Dri °LP Name of school currently attending: ah.erf-• osso(v‘ 1-_eodn Cer-0--er Name of ParentsfGuardlans: Female rade lave! for 2012-2013: -1 ‘‘-- vorc,7, Addll‘q 5) ci streett'd\ a r-r)'‘ cltyF L. State Zip Code 33 Home Telephone ft: Work Phone it: Cellular Phone*: (73 81) Email address: k i2., \‘1 CI re. Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 0: f 1 -LJ 1_1( THU) 15: 50 MTV NETWORKS LATIN AMERICA P,OU/00? How d d vou hear about the echoer/ f\-t-irt,n6ect uA-'- r-r-rec-Vt n@s op dcA-1-e, Ocktber I 9_010 Page 2 of 2 Submitted into the public record in connection with items Z. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please NI out one form per student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Student's : Student's Date of B or Vla fax te: 305-669-4390 Name of Parents/Guardians: kC uo1n-e‘-{-rz- Addrer114090 g‘SC Gi\-pC Street Name Telephone 4: Cellular Phone 9: Email address: C'1aie t Zip Code 33I Work Phone IR 3.5-531-47-1500S Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk j 'd XUJ 13CN13SU1 dH Wd80:6 0102 22 400 Now did you Marabout the school? frcry -) c-ritrY)114 f92eVO Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk d'd XLId 13rN3SH1 dH Wd90:E oIoa ee 40o Oct 20 10 10:56a Seaquarium 3053616077 p . 1 B ICKELL PREPARATOR A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or ACADEMY Via fax to: 305-669-4390 Student's Name: O3b)-e Lender: IMale Female Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: Grade Level for 2,012,-o13: 3. Ws 5ancL. Ancre(A) Atec-f-z. sc) -cuQQ V A--)civ1/44_ )..1 (forri CI-- -53 )31 Street State Zip Code Home Telephone Cellular Phone 4: Work Phone 4: ,WS-- -30 357 Email address: id you hear about the school? • 305 -2)(0-,)- 33 Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 20 10 10:56a Seaquarium 3053616077 p. 2 kgi F3RICKELL PREPARATCIRV ACAEIEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: O'ex(nsIQ Student's Date of Birth: I or Via fax to: 305-669-4390 ender: [1 Female Grade Level for 2012'2013: Name of school currently attending rfe iinP1 j(,{ (Pr- 5Ch03 Name of Parents/Guardians: ai() a Ailcfre c 4_4 4-7 Address: ,6C9D street 5nC 14'71) Q ) CIty State Zip Code Home Telephone #: CYS--5-1k.)91) Work Phone 4: 305- '3( (—) DS-33 Cellular Phone #: 3C;5---20 I :Y7)5- 7 Email address: fQ.Ar 1--11 How did you hear a ut the school? Page ipfi Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 20 10 10:56a Seaquarium 3053616077 P • 3 rKFI Stand with City of Miami residents in support of Brickell Preparatory Academy As a City of Miami resident living in The Roads / Brickell area, I can attest to the need for additional high -quality public school student stations in our community. This is why I am in support of Brickell Preparatory Academy, a K-12 public charter school that is proposing to open at SW 17th Street and 2'd Avenue. This school will benefit the many families who call Brickell, Roads and Coconut Grove home, especially those families who are looking for a quality middle and high school option close to home. I request that the City of Miami Commission support the families you represent and approve the Brickell Preparatory Academy project. na r-f 7 Name address Name -TZ 6 address Name Signature Signature address Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 5, SrAQJ (AA atA cat 0 Gender: Male 1SKemale Student's Date of Birth: 03- 0 '1,000 Name of school currently attending: Grade Level for 2012-2013: P0\0011\ Aa Name of Parents/Guardians: E \--Nrt),NAA Address: l00 k.k.) P---1) A rt arn.k rck (aew\ 'z 3 25 Street City State Zip Code Home Telephone #:,26-(=:31-lci 3 3" Work Phone ;t: Cellular Phone #(5.---14,(ii -in co Email address: E EFQLn ,fri How did you hear about the school? T-1\14,r C Ore-1 Page 1 Of I Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ZO/TO 30Vd TEZOLEV984 LV:ZZ OTOZ/GT/OT 305 01:2932 p.m, 10-20-2010 1 2 B.:,CKELL PREPARATO Y ACA EMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 -S. Student's Name: A 1-i DA S Gender: Male Student's Date of Birth: Female 4- Grade Level for 2012-2013: Name of school currently attending: IN DIN r€J2z2»TT Name of Parents/Guardians: A Address: t S Street Home Telephone #: g2_ Pt 41 -ie., 4 City State Zip Cede eY6c). Cellular Phone #: S Email address: sALLr\t-\ Work Phone 4: A Page 1 of 2 Submitted into the public record in connection with items 21.g--4. PZ•25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form eer student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Via fax to: 305-669-4390 Student's Name K M N OAN G- L Gender Male Student's Date of Birth: 01 1,27 /Loo4 Grade Level for 2012-2013: 4- Plame of school cunently attending: t AcAEL. «me A)cEL C_ATti 0 L I C._ S L Address: 0 suo azicte. "V tvVAMiFL 33i4S Street City State Zip Code Home Telephone 4: '30c — S 04 46 4. ‘-) Work Phone 4: 3C)&- — cgs 6 45 Cellular Phone 4: 30 - go 4 445 44 Email address: n te-A-0 e_g_O C.c.)-trn Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2012 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACA A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Student's Name: OILYWI I f r o. m fo,< Via fax to: 305-669-4390 Gender Female Student's Date of Birth: \t 51 taxi Grade Level for 2012-2013: Name of school c rrently attending: iccu5 eC&ram -tre WI Figme of Parents/Guardians: ufte,cit-rtr0 CU'O IC t FOX Address: SOH 6lA i Ct ram; Street Clty(Y11 Nn State L. Zip Code j 261 - Home Telephone #: ARO & goSR Work Phone #: Cellular Phone #: 30b r t-'t co -0(011 Email address: �� t t e—� +� y i r1' I. Q cyy Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How dld you hear about the school? 0, RCe )._1(1 Hu ttb ci 011 (calyx) 67) Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: Toseba A. Maruri Gender: X Male I] Female Student's Date of Birth: o8/26/oo3 Grade Level for 2012-2013: 4th Name of school currently attending: Coral Way Elementary Name of Parents/Guardians: Anthony Maruri and Maria E. Gonzalez Address: 45 SW zznd Road Miami, Florida 33129 Street City State Zip Code Home Telephone #: 3o5-8i6-8573 Work Phone #: 3o5-6oq-I179 Cellular Phone #: 3o5-6o9-1179 Email address: amarurina getinc.org How did you hear about the school? Meeting at the Conrad on October 16`h, zoio Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: fir% C' V V e S Student's Date of Birth: 9/?/a 3 N ame of school currently attending: as ✓C.o Via fax to: 305-669-4390 Gender: Male Female Grade Level for 2012-2013: 340/ N ame of Parents/Guardians:/ 14 1 Address: / 6/ C' :wQ, a ✓)ioir 2/6 /a Street �%s� P ? City State Zip Code Home Telephone #: 7'6 -Yoz- WYY. Work Phone #: 7d 6 - /oz - Cellular Phone #: c 3Z Email address: slcvizq dczyaioo ez)/) Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2of2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREDARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out one form per student and reborn: Vla mall to: 6361 Sunset Drive Mlaml, R 33143 Vla fax to: 305-869-4390 Student's Name: A /e)< c/r V/Ve Gender Ma Student's Date of Birth: jig /2 Name of school currently attending: /y\-- Af" c C0171e1" Grade Level for 2012-2013: 5"4 Name of Parenb/Guardiens: ev/v2;,,7 a-,77 /7A,7 afro kver Address: / 6/ crcv,6/0/7 )/ 79(4Z jizr(97.Q) Street City State Zip Code Home Telephone th YQ2-- 7-J-1-1 work Phone #: 7416 -- 1/02- Celkdar Phone tt: -7/f6 902-- Email address: 5/ c v 6.) • AX. „ Corr Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Submitted into the public record in connection with items PZ.24&PZ.25on 20'28'20 Priscilla A'Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: c,C,Act.)6k F - Studeat's Date of Birth: 1 qV Grade Level for 2012-20 : Via fax to: 305-669-4390 Name of school currently attending: na u / L 115 kpoldie Name of Parents/Guardians: )- /5 Aluxtb/e_ Address:/ '» 0,2,22 S-1-Kee -74" Home Telephone It: 5°5-7- 581(C2 "(..)5--40 Cellular Phone 0: 3137 Email address: z oudeo_. 3,‹ e Page 1 of 2 City State Zip Code Work Phone 0: Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk OCT-18-2010 10:51 P.001/001 BR ICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to:, 636x Sunset Drive Miami, EL 33143 1 Student's Name; or Via fax to; 3o5-669-4390 1N NEi- Gender; LI Male la Female ( �k� Student's Date of Birth; t 7,(710-3 Grade Level for zaiz-zo13: Name of school currently attending: .ki&c\0 kAA-2nAi Name of Parents/Guardians: , 2 l 1�j } Address: %\'U 1 qk L `CDJO 1 r f�.\t �r-� 1t 1 Z Street City State Zip Code Horne Telephone rx: LVS Cork Phone #: Cellular Phone #: Email address: How did you hear about the school? Zo.S _ Lro Page x of z Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk TOTAL P.001 OCT-18-2010 10:51 P.001/001 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per stizdent and return Via mail to:, 636x Sunset Drive Miaxrii,FJ. 33143 Student's Name; Student's Date of Birth; Gender; Male Female -221@lf3 Grade Level for 2.012-2013: k Name of school currently attending: Name of Paren V\ Address: 64C1I.Ed i14oso (AWA( Street ! City State Zip Code Home Telephone Cellular Phone lc Email address: Guardians: :(230,5 -23(0Z Work Phone (.26) ZO,c— ZOO) ki i*1 ec21-1.€0 (14 .(4.17( How did you hear about the school? Page x of 1 Submitted into the public record in connection with items PZ•25 on 1R-18-12 Priscilla A. Thompson City Clerk TOTAL P.001 OCT-18-2010 10:51 P.001/001 1341ICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636t Sunset Drive Miami, FL 3 143 Student's Name; Student's Date of Birth; (D Name of school currently attending: Name of Parents/Guardians: Address: U4CAk PUG A- GIo oc-1\ Street City State Zip Code Home Telephone a: ?f6 Z- Work Phone #: /CS ZOS-:Z(olt40 Cellular Phone # or Via fax to; 305-669-4390 Gender; LI Male Female Grade Level for 2o12-2013 Email address: INLU. 610N5 i\LEr How did you hear about the school? Page x of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk TOTAL P.001 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: ( ( Name of school currently ttending: V ( A \ e of Parenkts/Gu, ans: UVI k- 61V05 Address: or C- Vla fax to: 305-669-4390 Female Grade Level for 2012-2013: Street k--t1/4? A r3-C2 lc 3 3 ‘3 City State Zip Code Home Telephone #: - 6 Work Phone 4: cs) 31- -ova° CI —Dr) Cellular Phone #: S) L-(3' L Email address: L\S Sco ava • Al cSave; s'e Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? r s /() cc vLxr s-t / Sid, , 4 j1 S e-, c., ac, (. Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ICKELL PREPARATORY ACA A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Al Student's Date of Birth: N eofParentsl6 a lans: cc 7c Address: c tSA/L (-0 Street Home Telephone 4:G Cellular Phone 4: Email address: ss 01/4 or EMY Vla fax to: 305-669-4390 Gender: Male Grade Level for 2012-2013: .3(31 City State Zip Code Pt" ,E.6 6 Work Phone 4:0 c) 4 -Ori(/c) Page 1 of 2 0S-(0 740- AA CS c-L/0-5 c avc • e 52:ev Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How dld you hear about the school? rr 4.„ r SA-1- c3 -S • cj C CC_ Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk , 1.A 4 " ' 4 , A tuition -free public charter school Enrollment Form Please fill out one form oer student and return: Via mall to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: Student's Date of Birth: 0 Name ot school currently attending: eqi et Name of Parents/Guardians: Address: Sg Street LUt_a_r_q. Gender: Male -Female— Grade Level for 2012-2013: 7 City State Zip Code Home Telephone #: ig 4)- 4 WorkPhone #: 3 6c3 Cellular Phone #: 3 oc. Email address; 1--eC NIV (td into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk LP Pagel of 2 Nte A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mall to: or Vla fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: di\ Student's Date of Birth: Name of school currently attending: h-ei) Name of Parents/Guardians: ua Address: MC'S Street Home Telephone #11,55 c 14J- Actik-C Cellular Phone #: Email address; Gender: 'Mohr Female Grade Level for 2012-2013: 4 )1.4_ 6ct City State Zip Code Lc N Ok) Work Phone #: 30r (ScS41 Submitted into the public record in connection with items PZ. 2484132.25 on Priscilla A. Thompson City Clerk C.-11 Vvl Page 1 of 2 How dld you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk FIC K , A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 ADEMY /Th Student's Name:f/Zei.:1---,--"E„,e14(1/11 Gender: Male Female Student's Date of Birth: Grade Level for 2012-2013: Name of school cogently attending: 474-4Q-/ Name of Parents/Guardians: 7j, ,-16,177 44, V 0( ,C-titzaele 1,4 ufri Address:/a f Cc/1/-7— Street City State Zip Code Home Telephone #: Work Phone #: grz-/ns — Cellular Phone #: g'72-r Email address: -4 60 Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk V.=',F-i41CKEL: ;7.-PEPARATO N AC A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 4:74-/ Student's Date of Birth: or Via fax to: 305-669-4390 42-"ElleiegAin Gender: Male Female Grade Level for 2012-2013: g Name of school currently attending: Nam of Parents/Guardians: Address:// t' • 3 C.AP,ovr-1 Street A ""Z vi, z City State Zip Code Home Telephone #: Work Phone #: 0-/-,T67 6'02J0 Cellular Phone #: 305--ff;?-9- C:99Z Email address: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 22 2010 4:15PM HP LASERJET FAX p. 1 13RICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out one farm par student and return: Via mall to: 6301 Sunset Dries Illamlo FL 33143 Student's Name: A( exci r-Lciee_ R%-rTe 0 Via fax to: 305-609-4300 Gender: Male Female Student's Sate of Birth: 3 I 2 100 2- Grade Level for 2012-2013: Name of Parents/Guardians: 2-- Address: tbb Z. u-1 C.+ Street state zip coal, 3 2 3 2 5 Home Telephone N: Work Phone 0: 3°-C Sg-9t9 Calder Phone 4: 3_ 1 Email address: 9 S a_ K.o Lu 0+ rod% 1. c.ory, Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Now Ad yea leer OW the eoheert pep 2 el 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/21/2010 07:07 FAX 305 347 4825 MDC SEAP1 ACCOLNTING 2002/003 A tuition -free pi :Tharier sd-!oc! Enrollment Forme Please fill out one fjjistudent thrRE Via mi t 6361 Sunset Drive Miami, FL :13143 Student's Name: Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: ''' OT Via far to: 305-669-439D Gender al Grade t eve, lor Y012-2013: Street C." State Zip Cede. Home Telephone #: Cellular Phone #: Email address: Pane Work Ptione '.. f 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/21/2010 07:07 FAX 305 347 4825 MDC SEAPORT ACCOUNTING VI001/003 Date: To: Phone: From: Fax: MIAMt-DADE COUN'Y SEAPORT r.,EPARl'OEN'7- ' 1015 NORTH Am ERICA WAY, FLORiDA 33132-..2.01 - PHONE.: 905) 37-7672 FAX 329-4057 Phone: Total number of pages, includino this page COMMENTS. Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/21/2010 07:47 FAX 305 347 4825 MDC SEAPORT ACCOUNTING Z003/003 How did you hear about the school? Page, '2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/21/2010 07:47 FAX 305 347 4825 MDC SEAPORT ACCOUNTING Z002/003 Please fill out on :11 A tuition -free ouNic oharter sotton EnroiNment Form s udent a r farm Via !nail tw, 6361 Sunset Drive Miami, FL 33143 dr Via Tex tzr 305-469-4AD Student's Name: Gender Male Fem Student's Date of Birth: Graae weer for 212-2013: Name of schooR currently attending: Name of Parents/Guardians: Address: Street Horne Telephone #tr.' Cellular Phone Th Email address: City Sta Zp &Lade Work Pho e Page 1 of 2 Submitted into into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/21/2010 07:47 FAX 305 347 4825 MDC SEAPORT ACCOLNTING 00 I / 003 Date: MIAMI-DADE COUNT( SEAPORT LIE ARMEN 1015 NORTH AMERICA WAY, 2Nr" roAtvu, FL,CcRIDA 33132-2.01.: PHONE: 371 -7378 FAX 32,9-405Y To: N Fax: Phone: From: Fax: Phone: ; 4 Total number of pages, lnpluclin,c; page COMMENTS: Referenc- Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 21 10 0503p Emilio Martinez 305-G34-8108 p.1 IBRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fin out ono form per student and return: Vla mall to: or Vla fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name NA t‘ hoe. Ark - Student's Date of Birth: 2- — (c — of school currently attendin: ca_r- Chk hc,0-- C Name of Parents/Gisardlans: 5hr," r -1v-Icie 2 Gender Female Grade Lovol for 2012-2013: 4 c7 'NW 2.—ct_ Si— ; F 1 4-2_ :7 Street City State Zip Code Home Telephone ft: LI i C--)k Work 1Phone Cellular Emil address: cA\ Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 23 10 02:55p Emilio Martinez 305-634-8108 p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out ono form per student and r turn: Via mall to: 6361 Sunset Drive Wand, R. 33143 Student's Name: M. hae. I i`Acic Studenrs Date of BMW. 12- - - CY Name of PrentsFG 5be En Address: ) Cellular Phone S: Via fax to: 305-669-4390 2 ne • City State Zip COEN workphone tk Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk A A Al A AA AA AA A r 7- AA AAki A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: -F---F1 Gender: Male Student's Date of Birth: 1('' Grade Level for 2012-2013: Nam of school currently attending: 1€ 1\-, ki;j119,-: Ad-0)411/.1A_ Name of Parents/Guardians: Street City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: - 7 (4' (-c Email address: (-10/c.-1 L Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? • CQ r12 Page 2 of 2 Submitted into the public record in connection with items PZ•25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 25 2010 15:40:47 MET MSG# 55HH422H-HH6-1 Page HH1 Of HE Willis FAX Willis Re Inc. 1401 Brickell Ave. Suite 1110 Miami, FL 33131 Tel (305) 373 8460 Fax (305) 577 1081 Website www.Willis.com To: From: "Ferraro, Carlos" <ferraroc@willis.com> 3056694390 Voice: 305 577 1081 Fax: 305 577 1081 Date : Mon Oct 25 08:40:00 CDT 2010 Pages : 3 Subject: Enrollment form Carlos Ferraro, Account Executive, Willis Facultative, Willis Re Inc. Willis Group, 1401 Brickell Avenue Suite 1110, Miami, FL 33131. Direct: +1 305 373 8464, Mobile: +1 786 301 4823, carlos.ferraro@willis.com, www.willis.com THE WILLIS CAUSE - We thoroughly understand our clients' needs and their industries. We develop client solutions with the best markets, price and terms. We relentlessly deliver quality client service. - We get claims paid quickly. ...WITH INTEGRITY Click here for more information about The Willis Cause. Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Please contact the sender if you do not receive the number of pages stated or have difficulty with legibility. Please be aware that this facsimile is confidential. If you are not the intended recipient, please notify us immediately. You should not copy it or use it for any purpose, nor disclose its contents to any person. Oct 25 2010 15:41:21 MET M5G# 55004220-H06-1 Page 002 Of 003 BRICKELL PREPARATORY ACADE A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: ?A bLD FERR6 t .O Gender: Student's Date of Birth: iv/ 200 7- Name of school currently attending: SC icOLC - 3 -iC -E1L Female Grade Level for 2012-2013: Name of Parents/Guardians: CAP— t C)S F& -4 I Pc3 Mq-21 H sob p0000_0 Address: 2-151 OR /C K-ELL Ave. 9 M . M / 1 l , -I-L 33122 T Street City State Zip Code Home Telephone #: �B� — y`Ii-y1-()2 Work Phone #: Cellular Phone #: Email address: ri� ^ Sot_ rho°. coon. ar Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 25 2H1H 15:41:37 MET MSG# 55HH422H-HH6-1 Page HE13 Of MB Howdlilyouhearabouttheschool? -17t4 AS.Ci1 Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk URCKEiLL PREPARATORY ACAUEMF A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: Txr-rick /A. (Bekinca...4 Gender: Female Student's Date of Birth: 012c3V1(c) Narne of school currently attending: MAII, Name of Parents/Guardians: Grade Level for 2o12-2013: I I Sthwl 'Roo 616 vo Btfarica)4 Address: (6109 nu.) tih,S+ 14802.- H(qmii Ft 331 Street City State Zip Code Home Telephone At:W(0J Z?2J-7-324 Work Phone #: Cellular Phone #: Email address: en 5derl<ot y ho)'nic4,(. ctifYI How did you hear about the school? 4cier IAA'S 5e1A krn 0 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/23/2010 22:32 7865223279 SABADELL PAGE 01 / 0 2 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Plerselln out sal fanar stadaut and Marin. Via mall to: 8361 Sunset Drive Mlaml, FL 33143 or Ills fax te: 3054694390 Student% Kamm TL)1-trk f7. OHCZ Gelder: Mate .111"1111-) Sindent's Data of BIM Y 2 911' 0‘) tdeLmoIfer2012-2013 3rcl Address: 10 5 Home Tel eft rIK stow no aide 3 121 3D5 3;1 Li Z6C Email addresc o Page 1 el 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 1E1/23/2010 22: 32 7,955226279 SAB2DELL PAGE V_12/F_12 How dld you hoar obasil the school? vS‘ ON) `--za eEiJ THE SCH OoL ANJO 71-K00 G \kE)S ,fz\ GE Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Student's Name: 3alck\-on AUbnCaAriGender: Male Female Student's Date of Birth: 61-11- 05 Grade Level for 2o12-zo13: Narne of school currently attending: gliincircbah tity\rtcri-1-a-b44 Name of Parents/Guardians: V-kincok y(4- Address: (ao,Tinu.) 0131 -lin 't-/(orn. 5313(z) Street City State Zip Code Home Telephone 434 51334 Work Phone #: Cellular Phone #: CAS clni via-T\raA cci Email address: How did you hear about the school? Alex was en-)- r\ilvq hmie Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PR PAR AWRY' AEAD A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 636i Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: 1611(Y) .+ClrICCXja Gender: Male Ei<emale Student's Date of Birth: SI2D/01 Grade Level for 2012.-2.013: 5 Name of school currently attending: sunardooh t4eryur4oN Name of Parents/Guardians: ,n Kot_ .-f-c(n (curl Address: D nuv 4ZO2 Hrri Ft_ 5366 Street City State Zip Code Home Telephone #:(1.1i0 C1,5333c).4 Work Phone #: Cellular Phone #: Email address: C-nsder hafncol. cc-n How did you hear about the school? (fel Loz rr.v hme Page r of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk :KELL PREPARATORY AC A tuition -free public charter school Enrollment Form Please fill out one forrn per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: KaLidah H. Pd-a()CDA Gender: 0 Male EKemale Student's Date of Birth: 3(0) 100 Grade Level for zo12-2o13:741 Name of school currently attending: Cxyci Ik-Celekr Narne of Parents/Guardians: Address: &Iva Be+ancco4 6co nu) 6 1.852 Hiorni PL 331% Street City State Zip Code Home Telephone #:(713.1)) 163-3N4 Work Phone #: Cellular Phone #: Email address: C41 sdttw.f trdnY101 1 . COM How did you hear about the school? Ater was Yen% 1-o rr\ci hoL/Te Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10. Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Name: MI Belk Student's Date of Birth: Name of school currently attending: Name of Parents/Guardians: Address: I tic) Gender: Male Grade Level for 2012°2013: Home Telephone #: 3°$-- gior0- CA/ Work Phone #: 39 Cellular Phone 4g: 30r - ¶j - 21 Email address: r s.{ last1/4t.r As y How did you hear about the school? fa.xtficts Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please Fill ot one form per student and return; Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: itutna) Student's Date of Birth: Name of school currently attending: Name of Parents/Guardiaus: Address: or Via fax to: 305-669-4390 Gender: 0 Male Female Grade Level for zo:z-zo Home Telephone #: 30S.VM-1LIG Work Phone Cellular Phone #: 3a-1(•8-1(-81 rosy 6roccerokr yo..Lao. Email address: How did you hear about the school? crib. tr pAt e4d3 po CStF.50 Page i of 1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACAOEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: L(.'cs Student's Date of Birth: 5 07 Via fax to: 3o5-669-4390 cr Gender: ' Male 0 Female Grade Level for 20t2-2013: kleld Name of school, currently attending: LA Pr inA.A) Casa_ flowterS6r Name of Paren s Guardians: a-ntS Address: 1551 Soperix- kicruti Street 'pity Home Telephone a:3 t6- 641-1536' Work Phone #: Cellular Phone 3 oS- -0 Gr34.0 Email address: fries ni 15 How did you hear about the school? CititLc 0 State Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: a, s or Via fax to: 305-669-4390 &-I-efoccu4- Gender: Male Vale Student's Date of Birth: P)A?,icl1 Name of school currently attending: C Name of Parents/Guardians: Grade Level for 2,012'2013: Cl I UM C €iikck bt4onccu4 Address: (CO hW iztto HIOmI R. 32M Street City State Zip Code Home Telephone #:(118tD) '353-330,Th4 Work Phone #: Cellular Phone #: Email address: on 5 der Icoy ho-ky How did you hear about the school? PLier was cui-f- Inv licuse Page 1. of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/22,12010 07: 03 3052531485 STE'vENI KASSNER PAGE 01 02 g CULL PREPARATORY ,ACAOEMV A tuition -free public charter school Enrollment Form Please fill out one font uvr student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Of Vla fax to: 305-669-4390 Student's Name: 30„iu.i.e-, K&Sgeter Gender: Male Student's Date of Birth; 0 ti /Ci 12.000 Name of P G rd 0LIA, Address: Street 1 S • s La re— k4- Home Telephone #: *7 S-6 -Z r3 -72e Cellular Phone #: -7F - z-Ss Email address: Grade Level for 2012-2013: Dr, City FL stale 3 3t33Ep code Work Phone #: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/22/2010 07: 03 =41152531485 STEVEN KASSNER PAGE 02/02 How did you hoar about the school? ee i 1/6,1 P 4A Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill eut one per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 I or Via fax to: 303-869-4390 Student's Na Student's Date of Rift 3/69,, 1 o3 Grade Level for 2012-2013: K Nome Telephone #: 6/4. Cellular Ph EmII address: Page 1 of 2 State Zip Code Pho 5 6 7 9Dbr-7 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2012 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ORICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form par studont and return: Via mall to: 6361 Sunset DAM Miami, FL 33143 i or Via fax to: I 305-669-4390 Shid Date of Girth: I P-1 )0 1 01 Name wool cogently anegiding: 1011C1CA — riS Address: Female Grade Level for 2012-2013: Street City state Zip Code Home Telephone #i-gb (g-AVork Phone #: Cellular Phone #: 7gb- Bnall address: \ e/Q.)1.--Q, Page 1 of 2 5,67 Q.Z r-y• . rad Submitted Into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Now did you hear about the school? Page 2 of 2 Submitted into the public record |nconnection with items PZ.24&PZ.25wn 10+28'10 Priscilla A.Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one farm per student and return: Via mall to: 8381 Sunset Drive Miami, FL 33143 VIa fax to: 305-1389-4390 Student's Name: de, )n e• Gender: Student's Date of 13Irth: 7/103 Name of ParentslGuardlans: Address: 01Vo. 3,w. 3 -te:yr Street Grade Level L45 City Stets Zip Cede Home Telephone #: 173(0 3r14- 4-Work Phone #: Cellular Phone #: 1-g0 Page 1 of 2 5 6L)--1 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 22 10 08:46a H R 3055396232 P 3 BR1CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Student's Name: AC o E Student's Date of Birth: — — 0 4— Via fax to: 305-669-4390 C6D-11 Gender: Name of school currently attending: Cne-- Namu ot Parents/Guardia _a‘ inn Female Grade Level for 2012-2013: o() Street Th Home Telephone #:L\---i-ek)\ Cellular Phone Email address: \Ct c-k (0; City State Work Phone #: Zip Code Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 22 10 08:46a H R 3055396232 p.4 How did you hear about the school? acw .'- Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct22 10 08 45a H R 3055396232 p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: 1 Vla mall to: or 6361 Sunset Drive Miami, FL 33143 Student's Name: NI C k-O\L-1\1) C4-0- DE Vla fax to: 305-669-4390 Student's Date of Birth: CI - Name of school currently attending: 1.0 Name of Pa ts Guardians: A C---0 DIM CO, Address: \ ),) 5'3 2- Street ender: Male Female rAd Grade Level for 2012-2013: City State Zip Code Home Telephone (t: r I") Work Phone #: Cellular Phone #: Email address: e ( on Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 22 10 08:45a H R 3055396232 p.2 How did you hear about the school? tip 1 CXF:e LU.0 Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk CKELL PREPARATOQV ACA E A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Last Name or Via fax to: 305-669-4390 Student's First Name 0,t) Airc3eVIfiR Gender: FI Male Female Student's Date of Birth: la-1g Grade Level for 2012-2013: , I ;WIN Name of school currently attending: eritcn.+AR/ Name of Parents/Guardians: 3—P-a)r\ And 0(2.. A nab Al Z- Address: H766ui LVf Nk'Arvki Street Home Telephone #: Cellular Phone #: 3 City State 33 ill Zip Code 9CLt-711 09 Work Phone #: - 1-o as--? 'Aec,-1-ne.-f- Email address: Or e I 50 04e. AI Z pt ell uk -h , n *Your privacy is important to us, Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization. If the school o Mandarin ngual program, which language would you choose? (Choose Italian Portugese How did you hear about the school? cpuzd yr1. Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR C LL PREPARATORY ACAO A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Last Name Student's First Name Gender: 11 Male Female Student's Date of Birth: 03 or Via fax to: 305-669-4390 A ie Grade Level for zoiz-zo Name of school currently attending: 't" r A M • tiViii-e• Scl,00 I Name of Parents/Guardians: Address: 740 :YeAny (In(1 (Dg.lAnclo -1) A2- 6c,) MiAkt) ) PL 331iis Street Home Telephone #: 305-i5i-i L Cellular Phone #: City State Zip Code Work Phone #: Email address: (Dchil Z 14-(2 d .)c) LYHT) • in c d 42 i,611.sou4- it *Your privacy is important to us. Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization. If the school of bilingual program, which language would you choose? (Choose Mandarin French Italian Portugese How did you hear about the school? irt fine olA ; Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk tlow did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form_pfir student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Na Student's Date of Birth: or Via fax to: 305-669-4390 Gender Male.) Female Name of school currently attending: 44,Th dte- (CLI Address: Street Home elephone #: Work Phone It: Cellular Phone #: C193L-t-SIDLA Email address: E(QO trs H-)01(-1 Page 1 of 2 Grade Level for 2012-2013; City VA ; state zlp Code 3 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset brine Miami, FL 33143 or Student's Name: 0 Via fax to: 305-669-4390 Gender I fd Student's Date of Birth: z0c54 Grade Level for 2012-2013: 3 Name of school currently attending: E. Name of Parents/Gua 1sl��l, Address; Street Home Telephone #: s� City Cl State 33 ‘SgZip Code 3os-261-31•,53 Work Phone #: 30S - 3‘0 1,t Cellular Phone #: 181, - S 2. -- . -2_ 11 Se - - ©- 36 Email address: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& P2.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 22 2010 4:15PM HP LASERJET FAX p.2 How dld you hear about the school? -COO CI, CA w0 ke e Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name:` o,ELN \ e-wao Gender: I] Male,%CrFemale Student's Date of Birth: 131-j V2--- b Grade Level for 2o12-2o13: Name of school currently attending: Name of Parents/Guardians: 1 Q Li✓O Address: bU� /� �j_ �A C� Z� bL Street City State Zip Code Home Telephone #: C ) n — 134 )Work Phone #: Cellular Phone :Co')#as Email address: Sri C \-C \O S qC.C--7,��. • oibn How did you hear about the school? Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 1Ja13 AID uoschuogi -v ellPs!Jd OT-8Z-0T uo SZ7c1 217Z 'Zciswa 44!PA uo!pauuoD u! po3a.! ancind au; olu! pa1,1!LucInS BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: or Via mail to; 6361 Sunset Drive Miami, FL 33143 Student's Na ICIOCit0 Vi Via fax to: 305-669-439° 1Wer1C4Gender: ale Female Student's Date of Birth: I - 34 - DCC.)-} Grade Level for zolz-zoi3: Name of school currently attending: Name of Parents/Guardians: videt, 16-TE-e-il3or Address: 0-1,As NE 1(6* kid tAk AIM\ Street City State 573‘31__ Zip Code Home Telephone 44: Work Phone #: 1038' Cellular Phone #: 306• Email address: K50t,N01 i)rti How did you hear about the school? q7 0 • 901 8/ cAck±r VD)PcIca2 plzp (al 4ne(1t3 , oCe -11Aeo u-ks Octue a-kfcled PNLA1N)6 in Cciui arid Conract -(c) skaci,\) our &woo+. Page i of Oct 25 2010 1:20PM HP LASERJET FAX p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: or Via fax to: 305-669-4390 Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: .---11\liCk 1"A elfeS Gender: Male Student's Date of Birth: 01 \ Grade Level for 2012-20 Name of school currentlyationdi : 110:er &R-11)1 Address:/OIL+ SLA) cl cofe Ho Street 33lO City State zip Code Nome Telephone #: 781.01-1C1C1 - COLA C1 • Work Phone #: 3D5-31-1_ a-141 Cellular Phone #: Email addreq: NOCCDti i41 I( Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 25 2010 1:20PM HP LASERJET FAX p . 2 How did you hear about the school? @icy received cd home_ Page 2 of 2 �j�1ViCi1C� __ sAuc -- OcLrrner ibJrarrO , f r Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk DRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to: 305-669-4390 Gender: 0 Male Female Student's Date of Birth: Grade Level for zo1z-zo13: Name of school currently attending: L114' 1 arcieSS err Name of Parents/Guardians: Address: st-J to .SA-- • titet..14-1. Street City State rz- Zip Code Home Telephone #: 30S.' g(r0- (At Work Phone #: 3075- - (154- Cellular Phone Phone 4,t: Email address: 30S- ros‘f lora_c...er as y How did you hear about the school? ecut.".7i-s ("to • C...erv--r-1 0 Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Or Via fax to; 305-669-4390 Student's Name: LL/CMS k(AiNterei Gender: Male 11 Female Student's Date of Birth: 51i 0 2�o7 Grade Level for 2012-2013: kiildtrjaert Name of school currently attending: La Pr;..) Cat et_ 11vEessi. Name of Parents/Guardians: -aits grttceArti-S 4 Br an kern ere4-- Address: 1551 S'opefo-- 671--ca 614,410 3 11-. Street City State Home Telephone : 3 (f1.- 15369 Work Phone #: 546—E— '3 610-0 #3 Cellular Phone #: 3 05- fD1 - Email address: 14 (S WI l I 5 ec,0 1C,610Y1 How did you hear about the school? Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: 61.60/1 et) koSe. etdro-Y1 Gender: 0 Male male Student's Date of Birth: 8123 Loci Grade Level for 2o12-2o13: kind r Name of school currently attending: La. Pr intik.) C0.161, LeSs_15111 Name of Parents/Guardians: (R0.3 G thiLVD PatiCr Address: Street Home Telephone #: Cellular Phone #: 30.5- tog' 1(07i I Email address: rosybra c eras y 1140 SW 10 S-t- • etsu• tf2 3313 0 City State Zip Code How did you hear about the school? Work Phone #: 3 S- G5if- 50 )- Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: -C&:1- r" P!i L: Ct Gender: Male Female Student's Date of Birth: �� \ C-4 I Gj (. (, Grade Level for 2012-2013: C j Cf Name of school currently attending: HTh Name of Parents/Guardians: F Y M 1 l U C\ p co cf—Dd LN. C Cam, r C� C11IC�_ Address: C;(v / Street P-v , City State Zip Code 33 5-6 Home Telephone #: � � �� 4 7 O L-H Work Phone #: 3 C m- 7 C L L Cellular Phone #:77--,7 - CD3C —� Email address: Cyr rvn C:4 f -) Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? -k-- CC Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICK PREPARATORYACAUEMV A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Or Via fax to: 305-669-4390 a ski' Tftiart7a,\)14- Gender: Male Student's Date of Birth: pPosicil Name of school currently attending: Name of Parents/Guardians: P4:male Grade Level for 2o12.-zo13: Cby 1 (-00 I<3 Cerkr be-i-ancw(4- Address: 603 }IL() (I1k)c54- -#:No2 HiOrni 33) Street City State Zip Code Home Telephone #:(76i1)) '353-33A Work Phone #: Cellular Phone #: Email address: Dri 5 d-er CGI How did you hear about the school? dyer as ce()+ +0 hcule / coo Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATOR ' ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Via fax to: 305-669-4390 Student's Name: Kalidah H•BO-anca.Y4 Gender: 11 Male E''Female Student's Date of Birth: (6(0i 100 Grade Level for zotz-zot3: 4-1 )1 Name of school currently attending: OPYCI Narne of Parents/Guardians: Address: to) nu) Ct 3 1802 Street Horne Telephone #:NP) (g53-34 Work Phone #: Cellular Phone #: Email address: N sderatir r"t*YY1a 1.ctrn Behocco- iarni Pt_ 37313( How did you hear about the school? Ailey was Seri 1-t) hoLtie City State Zip Code Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-2 0 Priscilla A. Thompson City Clerk BRICKELL PREPARATOPV ACADE A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: ‘1Chla &-1l1( or Via fax to: 305-669-4390 Gender: Male Etemale Student's Date of Birth: aq 12010 Grade Level for zoiz-zo13: Name of school currently attending: ShliflorC100Y) t4erYlini-ON Name of Parents/Guardians: ?rim '-f-cinci.ty-t Address: iDntx co+05 .:14 _802 Street Home Telephone #:(,130 ‘8,53,35d* Cellular Phone g: Email address: Croder How did you hear about the school? u4S 14 ij hcu orn City State (53HCO Zip Code Work Phone #: 1 col-) Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk CK LL, PREPARATO—RY ArADEmy A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Narne: DerrtCKA 'Be-kincLui/J- Gender: l'4;1.ale 0 Female Student's Date of Birth: olz-st% Grade Level for 2012-2013: 1 I Name of school currently attending: MAIO k SC-OaA ROA CICI Name of Parents/Guardians: Er( Ka 2)(-1-arra)/4- Address: (6C0 nU) liTh,S± f4 30,2- t-14rn; j FL 331 (12 Street City State Zip Code Home Telephone #:k.736) 853-34 Work Phone #: Cellular Phone #: Email address: en 5 de/1<o1 y et hotnicii 1cowl How did you hear about the school? Page 1 Of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BR CKELL PREPARATORY ACA E Y A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: ') Student's Date of Birth: or Via fax to: 305-669-4390 Gender: gale Female 0-1\-05 Grade Level for 2012,-2013: ft Name of school currently attending: ak.6)C3/40CIDah Bn-Y1-Cir1rcfv\-1 Name of Parents/Guardians: Address: ncwr CoCOnu3 (17015 -Nut) flOrn R\3L0 Street City State Zip Code Home Telephone it:WC-653-33D4- Work Phone #: Cellular Phone 4: Email address: uks cityLcij '6-3) How did you hear about the school? —Nef was scal- 4D rv\I hcsus Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk From: 10/2112010 09:44 #017 P.001/001 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's NameffS':- c e Student's Date of Birth: or Via fax to: 305-669-4390 Name of school currently attending: Gender Male Grade Level for 2012-2013: Name of ParentslGuardlans: Address: ()a 3 7*() (vAL -3 3 I city i.state L Zip Code 371 ki Home Telephone #: Work Phone #: (30 ) g I k•-c, Street Cellular Phone #:( fiq Email address: \\,0.110-NA . (Go(T) Page 1 of 2 Submitted into the public record in connection with items PZ. PZ•25 on 10-28-10 Priscilla A. Thompson City Clerk 21. 201:1: '1:1134m Al 656 How dld you hear about the school? Page 2012 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk " . 6 6 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form usr student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student Na Student's Date of Birth: 10 Name of school currently attending: c14-xx-Irin Hinir Name of Parents/Guardians; Arlo rnO+r)-Cr Address: Via fax to: 305-66B-4390 Gender. e Grade Level for 2012-2013: Street City State Zip Cade Home Telephone #: 54*SE-V-c116 -SL Work Phone #: 2i.5-- 043 ---3,5P53 Cellular Phone #: a)5 q 6 Email address: Page 1 of 2 ...=.00111OMM Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk n 21 '4.1,nAV 66F,6 Haw did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: RI -s50 Student's Date of Birth: Oty Name of school currently attending: Address: rO Street Via fax to: 305-669-4390 Gender: Male 03 Grade Level for 2012-2013; L4 ts" 1-t41-ea b , I 3301 Q City State Zip Code Home Telephone #; 6 -5 .3 fc, Work Phone #: Cellular Phone #: ap5 - 515 -. 51 36 Email address: QD.Ver Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk m:Terra Group Accounting Department To:Brickell Preparatory Academy (13056694390) 11:59 10/21/10GMT-04 Pg 02-02 —14 6 A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to; G361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth; 101cti 05> or Via fax to: 3°5-669-439© Gender: 'Male *MI* A L1 Female Grade Level for 20:2-2013: K 3 Name of school currently attending: - PiTSCha)) mom, beacii Name of Parents/Guardians: all a 41 (Ab. I i icfC) Address; 1-10 S VO 014 Ter/0 &I ICI in it 3312.9 Street Horne Telephone S(O 0DWork Phone t±: Cellular Phone is'; 7(0 1173 Email address: 64 p @_ y 0 c) How did you hear about the school? City State Zip Code Page i of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk m:Terra Group Accounting Department To:Brickell Preparatory Academy (13056694390) 11:59 10/21/10GMT-04 Pg 01-02 A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FI. 33143 student's Nanw: L a u rey) e or Via fax to: 305-669-4390 Gender: [ Male g/Fei a e Student's Date of Birth: 1J)9 I NO Grade Level for 2,012--2u13: Name of school currently attending: Si-- ?GN, CV s Name. of Parents/Guardians: C•ri - an ar0 tOccia lie Nie.1-0 Address: 'Te YVtU. 7/ii041; FL - City State Street Zip Code Home Telephone #: 305 B1-90 —C)5C-C) Work Phone g: Cellular Phone 7scp- Email address: no 1- tri p Tir) /alio° .c fyi How did you hear about the school? f Y1 cod 13ectc.h 3DS I-Hu-A-(5510 Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 21 10 11:57a CITY CASH LLC 305-415-9690 p 1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form oer student and return: Ilia mall to: 6361 Sunset Kirke Miami, FL 33143 Student's Name: S4klel V. NA Via fax to: 305-669-4390 Gender: Male Student's Date of Birth: 101in 1200n Grade Level for 2012-2013: K. Name of school =reit jaIrtritlaCi rre meofPare nWeuardia ns: no gala / I.Porrircia Ica • ctla Po.( D( 4224 Mikt\I Pt_ 31-31 Street City State hip Code Nome Telephone #: - Lin • CICISO Work Phone #: Cellular Phone #: &J '615E322Q Email address kierior ro @> 61 mai [. Pane 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 21 10 11:57a CITY CASH LLC 305-415-9690 p.2 How did you hear about the school? ftmAcrld. Page 2 ctf 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 21 10 11:55a CITY CASH LLC 305-415-9690 p.2 How did you hoar about the school? POS CSLCCI Page 2012 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 21 10 1155a CITY CASH LLC 305-415-9690 p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 _J Via fax to: 305-569-4390 Student's Name: SafQh 1 ROQ Gender: Student's Date of Birth: 05 131 (260G Name of Pantnis/Guardans: Lilian Plow to -Vcri ipantartio Grade Level for 2012-2013: 1.3r Address: aco IcKelt ex.ui 421024 Ftcnt1 iL 3501 Street City State hip Code Home Telephone #: ZO5 4 15 ctc:150 Work Phone #: Cellular Phone #: Mb• %15. 22P1 Email address:, 1C11C1 zar co t hot mai 1. corn Pane 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 2 ' 41 AM M VE'HR01_0v \ 6692 4 How did you hear about the school? rnatileA Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk . 21.2f :4(2AM 692. BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out tile form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Namo: Student's Date of Birth: or Via fax to: 305-669-4390 Name of school currently attending: R-e Address; Street Gender, Female Grade Level for 2012-2013: Wry State Home TeloPhone #; 91-6 513 (;:a_ Work Phone #: 2C6-__ZL13-3,5P53 Cellular Phone ft; ap6 Email address: CAC>kr a (lewd si 36_ -eciu Page 1 of 2 Zip Code Submitted into the public record in connection with items PZ. 24& P2.25 on 10-28-10 Priscilla A. Thompson City Clerk 2'. 21 Howdidyouhearabouttheschool? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 171`. r-tr,t1 6632 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out one tormpor shident and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or Via fax to: 305-669-4390 Student's Date of Birth: Name of P Ar-y) 0 Ub e_r Address: (4)D E Street Home Telephone e.)43-asE53____ Cellular Phone #: W5- c.-41 Email address: Q04-e Gender. Male Grade Level for 2012-2013: City Paoe 1 uf 2 State lone Zip Cade Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 8RICKELL PREPARATORY ACADEMY A tuition -free public charter school Please fl�ou0n1 Via mall to: 6361 &mud Drive Mlaml, FL 33143 d Enrollment Form t Student's Name: A na6of I borrot Student Date of BM 5 )sJ 2.00—+ molder Phone #: Email address: city Page I of 2 Vla fax to: 305-669-4390 Male Grade Level for 2012-2013: te Zlp Code 805.- Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you bear aboW the school? Page 2 of 2 Submitted into the public record |nconnection with items PZ.24&PZ.25on 10'28'10 Priscilla A.Thompson City Clerk N10'5S F'HGE 01:' E1 2 BR1CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please f111 out on folr per student and return; Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Nair o�fco Nam Add Parents/Guardians. Street Home Telephone #: 3'0 5-- 3 tI Cellular Phone #: or City Via fax to: 305-609-4390 State Zip Code ork Phone #: 305 - 3 $ - ?T.' 1 Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out ono form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Name: J50-fro (Pie Gender: Student's Date of Birth: Name of school currently attending: OnrAtro r-trie 10( 4 1st ( Najiie of Parents/ uardlans: CoE vici,A0Z Female Grade Level for 2012-20 Address: 5(--)00 IJE I Opf. TC 33(57 Street City State hip Code Homo TelephoneWork Phone 4: 30-5- "Lf I Cellular Phone 4: 776 —49 6 7--/ Email address: --4/1*,' 5 S (rv-r) Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk F BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami,. FL 33143 Student's Name: JO Student's Date of Birth: Name et school cu 'Yr? ti'7 or Via fax to: 305-669-4390 attending: / tivig 07/ e01 Parents!Guidians; O. Cll. L--; 11'1.11 1 r`ce Address: Gender: Grade Level for 2012-2013: Li Street City State Zip Code Horne Telephone #: Work Phone #: -3 I Cellular Phone #: 774 7— / 6:1;7c / Email address: ktt S s tta hi 0. 0.2K1p-f Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school'? (.49 (6; rad giSira(C)( ' Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/25/2010 012E FAX R1002/003 DRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form oemoludent and return: Via mall to: 6381 Sunset Drive Miami, FL 33143 Student's Nama: or DIEGO GAMARRA Via fax to: 305-669-4390 Student' t of Birth; JULY 2ND 2005 Name of school currently attending: SOUT Name of Parents/Guardlans: ALEJANDRO GAMARRA Gender: Male Female Grade Level for 2012-2013:2ND GRADE SSICA IRIZARRY Address: 770 CLAUGHTON ISLAND DR APT 910 Street Home Telephone #: 305 _ 546 1690 Cellular Phone : 305 742 3602 Email address: 33131 City State hip Code Work Phone #: 3 05 742 3602 IZARRYcGMAIL. COM Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk EPARAT RY AC EMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name Student's Date of Birth: N ame of school Currently attending: Via fax to: 305-669-4390 UeZ Gender Male Grade Level for 2012-2013: K 2 N ame of Parents/Guardians: Address: 2) (0(e cS Street y� Home Telephone #: ©b Cellular Phone #: CI 0 Page 1 of 2 State Phone #: - 33‘L/5 Zip Code 5- 6- Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear about the school? Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk CKELL PREPARATORY ACAIJ HY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: VIa mall to: 6361 Sunset Drive Miami, FL 33143 1 or Via fax to: 305-669-4390 Student's Name:Ni ak0 CLS r9 u abt ende r: Student's Date of Birth: I PI )0 01 Na ool currently atlepdhp: iCICA ftS Name of Parents/Guardians: Street Female Grade Level for 2012-2013: b Gr6c1 SA,NooL City State ZIp Code 4-(-) Home Telephone ;-:-/g bSiyork Phone : 5 5- Cellular Phone #: -7gb 3Y-7(4- - Email address: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk How did you hear abo Page 2 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 8RICKELL PREPARATORY ACA A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or El Via fax to: 305-669-4390 Student's Date Date of Birth: Name of school currently attending: Gender: Male ( emale Grade Level for 2012-2013: Name of Parents/Guardlans: Address: Street 1; .1., -±3 ) City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: c Email address: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 8RICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Vla mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: 4 ‘. r or Vla fax to: 305-669-4390 Gender: Female Student's Date of Birth: Grade Level for 2012-2013: e of school currently attending: Name of Parents/Guardians: 11 1" Address: Street ! ' I I / City State Zip Code Home Telephone #: Work Phone #: Cellular Phone #: Email address: L Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk EMI KELL PRE PARATORY .4,CADE.MY A tuition -free public charter school Enrollment Form Please fill ou : one form per student and return: Via mail to: 636t Sunset Drive Miami, FL 33143 Student's La it Name or 0 zA Student's Fi:::5t Name M 4 14 i4 Gender; I.; Male Female Student's ar':e of Birth: Name of scli :)ol currently attending: Via fax to: 305-669-4390 Grade Level for zo;-zot3: ae L7tr GescA o) a:2E Name of Park:nts/Guardians: ancie._ rn \ D Mo{An c2!-' 0 SO -PrYC Address: OC frt l'a V Street City State ::ip Code Horne Telep'lone #: -12-3- 3 "7 -2 Work Phone 47; 9C-114 2 ;3 Cellular Pho 41: —74 Email acklre:;:;: toL-H 1_2_9 4 h 1)D- 66)1(1 *Your privacy important to us. Mater Academy will not share, sell or disclose y .1,r personal information to third parties. It will only be used to transmit information pertaining to our organi: If the school offers a biling a Mandarin French I -low did you hear about the c hool? a which language would you c9se? (Choose t) Portugese OLi 2 7 0 a 1 n 1 6060 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk TO 39Vd HOO'Neini -16012--EU-VSE, LI? :ET OTOZ/22/0T 10/27/2010 13:54 FAX BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form. per s den Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Na Student's Date of Bir Name of school currently attending: Name of Parents/Guardians: Address: nd return: or Via fax to: 305-669-4390 VGender: Male 0 Female Grade Level for zoiz-zo Street City Stat Horne Telephone tr:1X, -79 -73 Work Phone tt: Cellular Phone #: 73 Co 3 Email address: J e In CA I 3ce How did you hear about the school? Page I of Zip Code Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk ,s2iv BR r-KE' L PREPAi-<AT-3RY ACADEM A tuition -free public charter school Enrollment Form Please fill out ene term per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: Student's Date of Birth: Via fax to: ' 305-669-4390 _Th All A_ ai6ti-nr‘- Gender Female Grade Level for 2012-2013: Name of school currently attending: .1 Name of Parents/Guardians: ufc(,9 s «4 Address://‘ - 7 _5 0 Street City Home Telephone 4: Work Phone #: Cellular Phone it: 5)5 Email address: /-0 Zip Code 1 t) Page 1 of 2 d Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk c r c C SRICKELL PREPARATORY ACADEMY A tuition -free public charter school How did you hear about the school? Enrollment Form Please fill out one form per student and return: c u a Via mail to: or Via fax to: c 6361 Sunset Drive 305-669-4390 ,- c Miami, FL 33143 4 a Student's Name: P(; f iGi \F (1(t? Gender. Male Female Student's Date of Birth: (S — - L{ Grade Level for 2012-2013: 3 Name of school currently attending: ".•.•nc; - ¢i tczCiC r, Nagle of Parents/Guardians: Address: _ Street City State Zip Code Havre Telephone #:. S/ � f .: - c:lG ;q. `( Work Phone ii: Cef ular Phone it: Email address: ` r•- j r tL. Cam{ M Page 1 012 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Page 2 of 2 BRIC:KELL PREATORY ACACEI'vlY A tuition -free public charter school Enrollment Form Please fIll out one form per student and Felon; Via mall to: 6.3$1 Sunset Drive Miami, FL 33143 Student's Name: or Via fax to: 305-669-4390 Student's Date of Rifle 1-g- 7 jender MC.,.!!) Female Grade Level for 2012-2013: Name of ElooI currentlycurrentiy attending: — E_ Name of Parents/Guardians: F i • Address: ) ci `S'y...; 2 Street CIty State Zip Code Nome Telephone #: Work Phone It: cemarpi..#: 305) 19 --q9(oci Email address: h•-kv-r, e%.2__c-- C C Page 1 et 2 How did you hear about the school? (-) Page 2 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out ono form per student and return: Vla mall to: 6361 Sunset Drive Mandy FL 33143 Student's Ma : I r4.1 e Vla fax to: 305-669-4390 . Female Student's Date of 13 \L7—CDc7 Grade Level for 2012-2013: Maine of school =rune" attend C. h lc -kb Pre L-1- Name of Parents/Guardlans: ne Address: Horne Telephone 1/: '7c7 Cellists Email address: City Stite Zip Code Work Phone \ c)u4h. ()et - Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28- 0 Priscilla A. Thompson City Clerk 1 d BOIB-4,E9- zauTu-lew QIIW1 dE34;E:n ni c uon 10/26/2010 4:06:42 PM PAGE 3 OF 4 A tuition -free public charter school Enrollment Form Please fill out one forrn per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Last Name Student's First Name Gender: II Male Female Student's Date of Birth: 5 or Via fax to: 305-669-4390 Grade Level for 2012-2013:N' Name of school currently attending! V--\(\C\K Cla. Name of Parents/GuardiansQ-Ck QC-1'1(4A Address: k D S A SV k-\ 0 p Street City State Zip Code Horne Telephone #: Work Phone #: S3RC-6:Dg Cellular Phone Email address: OCAQ_(--) C Your privacy is important to us. Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization. lf the school offers a bilingu , which language would you choose? (Choose 1) Mandarin French Flow did you hear about the school? C-Or 12Ar1r1l tugese Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 2G 2010 1:12PM HP LASERJET FAX p . 1 IA: 2 BRICKELL PREPARATORY ACADE A tultlori-free public charter school Enrollment Form Pismo fill out ooe form oar student and return: Vla mall io; r Vla fax to: 6381 Soneol Drive 305-680-4390 Miami, PL 33143 Student's Nama:L996ELA t Gender: Male Sludent's Dato of Birth: • 0 6. 2001 Grade Loral for Z012-2013: Address: Streit CityrrIONistats FC, zip cow 35/349 Home Telephone # Work Pima #: Cellular Phone IR A - 39q1116 Enutuaddr- sa bola. 4) halm(' / coo2 Pagel of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 27 10 0713a Vista Construction Servcs 3052855844 p.2 BRICKELL PREPARATORY ACADEMY A tCtion-free public charter school Enrollment Form Please fill out one form per studant and return: Vla mall to: 6361 Sunsel Drive Miami, FL 33143 or Vla fax to: 305-669-4390 Student's Name: tOrifirto iqeocli. of Gender: Male Fem2_1J..) Student's Date of Birth: D-/- lariCi- Grade Level for 2012-2013: le) Nameof school currently atte c- • A, -1--t VA-0 Name of Parents/Guaplians Vi Cl Yi?C? Address: Street Home Telephone #: City State Zip Code ark Phone #: Cellular Phone #: (c, - 4 4-_3kL - Email address: Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 27 10 07'13a Vista Construction Servcs 3052855844 p BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name Student's Date of Birth: C Name of school currently attendi - i4-1-beW 3 or Via fax to: 305-669-4390 Gender, Male Grade Level for 2012-2013: Name of Parents/Guardians: V) \()011 (4 kerl j I r) P4E(Y1I 2! Address: Street Home Telephone 4: V 22)-1-rry0cP A--6o1r)) City State Zip Code Cellular Phone #: Page 1 of 2 k Phone : Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 26 10 09:12p Alexander James & Co. 305.374.5119 p.2 A Tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: or Via fax to: 6361 Sunset Drive 305-669-4390 Miami, FL 33143 Student's Last Name Student's First Name Gender: LI Male Female Student's Date of Birth 7 Name of school currently attending: Grade Level for 2012-2013: Name of Parents/Guardians: Address: 1171 c'ICO ey (L7 Q I Street Home Telephone #: .-.2).7-1•..) • 5 Cellular Phone #: Email address: ime le .7r)k.c.?' o City et LA-11 L 3 State Zip Code Work Phone #: • 3 -1'1 • 26 L;', *Your privacy is important to us. Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization. lithe school offers a bilingual program, which language would_you-choose? (Choose 1) , ,---:------- Mandarin French Italian Portugese How did you hear about the school? ; 0eA../J i oit II•t) - 'IA lie / r: -/•/ .. vi! e ( ‘C) i-4/A 4) ,\J Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 26 10 09:12p Alexander James & Co, 305 374 5119 p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 or Via fax to: 305-669-4390 Student's Last Name Student's First Name Gender: I1 Male Female Student's Date of Birth: Name of school currently attending: c4 Grade Level for 2012-2013; — • iZ Name of Parents/Guardians: 0 Address: fi P6— 3:'3/_) street City State Zip Code Home Telephone #: 0 -S 4-11 Work Phone #: 307T ;• Cellular Phone #: i3c390 Email address: ) 114 fe_r-z) oiAti *Your privacy is important to us. Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to Uansmit information pertaining to our organization. If the school offers a bilingual program, which language wo Mandarin French Italian Portugese How did you he about the hool? &iqC(?. e? (Choose 1) Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 10/26/2010 20:48 FAX 001 BRICKELL PREPARAT RV ACADEMY A tuition -free public charter school Enrollment Form Please fill out one Form per student and return: Via mail to: 636i Sunset Drive Miami, FL 33143 Student's Name: C‘..),L2-(;) a_ Student's Date of Birth: ( I 5 ) Name of school currently attendin Name of Parents/Guardians: J...e Or Via fax 305-669- Gender: Grade Lev Address: (-7° 46 31{ (le Ipe Yu)-12 Street Home Telephone #:1 (3(.0 (-1-h, 79 73 Cellular Phone 0: Work P Email address: e V 0-11 one #: 0: 4390 Female for 201220 How did you hear about the school? cLP 1 0-0vi k Page 1 of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 31)-9 BRILKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunset Orlye Miami, FL 33143 Student's Nam: )/c1. nn a Ni ( 0 lc der /7 ta_nde z Student's Cate of Birth: - 0 q- Via fax to: 305-669-4390 Gender Male Grade Level for 2012-2013: Name of school currently attending: M-Lni ninho Pr‹,pa_ra_lcrV Name of Parents/Guardians: NoLtst. nonza_162_ Address: 00 a -ten dg. 40 4 icty oiscayn6 7q,)331qq Street Home Telephone Cellular Phone ##:() 610 .5 50 2 I Email address: MA-01 aonza_l_ez_ 2 City State Zip Code Work Phone #: -Le /es -Le Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk i d nr17()-QCQ-cnc eUUIN-IllelAl dric111 ni q7. BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill owl one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Naeae Via fax to: 305-669-4390 Student's Date of Birth: or to 6- 10.2 Name o chool currently attending: hie rr�� ,Schoo of Pare its/Guardians: ( Gender Male 20Fate Grade Level for 2012-2013: v' / Cc.Y1©S -C 1%-. Address: 17,13 S cl A ve e A-f Street City M ;State FL zip code 3 3 Home Telephone #: Work Phone #: 3 CAS - '- if 6 's,� Cellular Phone #: 30 5 502,25 ‘d Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk mmn-ono-cn^ dni :an ni 07 icn BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please MI out one form per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Name: br un o a4 r? Via fax to: 305-669-4390 Student Date of Birth: 2-)2./OL Gender Grade Level for 2012-2013; k-i1-0-61j Name of school currently ndIng:. PA-(11 1 linho -6111 oha P r-cp ez. ra_f-e k !lame of Pareuts/Guardiams: /-1 JGcliala Iba0Inlpa_410 /)) Address: Street 3312q City State Zip Coda Home Telephone #: Work Phone Cellular Phone Email address:' acf rin7o-oco-cno ) 75-L (o(t7S-C() hcrt-rnaj I . corr Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Clt7L:QC1 n L c17 Ion 10/27/10 13:22 FAX iA001 Address: A tuition -free public charter school Enrollment Form Please fill out one form,per student eturn; Via mail to: 6361 Sunset Drive Miami, FL 3343 Student's Last Name Student's First Nanie GAZ or Gender: LI Male VFemale Student's Date of Birth: 10 1 1 /.2Q 0cl Name of school currently attending: Name of Parents/Guardians: t. IAJ S (2' S-4 0 ro-n ta. Street City State Zip Code Via fax to: 305-669-4390 \OL Grade Level for zoiz-z0i3: I Y Ck Horne Telephone "5 0 41/4-13- Li 03 Work Phone o: Cellular Phone*: -605- q9a 411-a Email address: Gs; MA -I.-LA n"-e C.,0 *Your privacy is important to ua. Mater Academy will not share, sell or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization. ol offers a bilingual program, which language would you choose? (Choose' French Italian Porcogese How did you hear about the school? Urnc Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out en. form Der student and return: Vla mall to: 6361 Sunset DAM Mlaml, FL 33143 Student's Name: LA) or Vla fax to: 305-669-4390 flC\cALU Gender: Male Student's Date of Birth; 5 2 Ok-k Grade Level for 2012-2013i 3 - Addre Thi)(-3,(up (Di SCO ?-67" Street City State Home Telephone 3 Li 9 3 Mork Phone 9: Cellular Phone NI 8 S ? ( Email address: C.0111--? Page 1 of 2 Zip Code Submitted into the public record in connection with items 1,_'lagt PZ•25 on 10-28-10 Priscilla A. Thompson City Clerk TAO/TOO 0] XVJ OT:OT OTOZ/RZ/OT BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please flit out was form oar gjot entl Vla mall to: 8361 Sunset Drive Mlaml, FL 33143 Student's Na (;) t) hoc\ Student's Date of Blau (? 3 \ Address: \CKALL T e Via fax to: 305-569-4390 R City State 3? wort Phone #: cellular phone th as Email address; Page 1 of 2 Zip Code Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 1-00/7.7002] 3N3 OT :OT OTOZ/SZ/OT BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Meese MI out one form IMF student and ream Vla mall to: 6361 Sunset Drive Mandy FL 33143 Via fax to: ; 300-680-4390 Stud ; co \ swears Date of Birth: 12 Address: 1-1? 0 ale Grads Level far 2012-2013: 0\r2x kucoPito 331Hr Ctty State Elp Code HomeHom,TeleVhone#3'k3 Work Phone It: Cellular Phone ez 3'89- ciLt1-4 Entail address: L Page 1 of 2 Submitted into the public record in connection with items PZ•25 on 11:1-1L1---° Priscilla A. Thompson City Clerk 1-00/C00Z Xrd OT:OT OTOZ/RZ/OT 10/28/2010 08:07 FAX 3054487085 PIEDR.A & ASSOCIATES Z 00.1/001 BRI C ELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mail to: 6361 Sunsei: Drive Miami, FL 33143 Student's Nam or Student's Date of Birth: I(/Z+,,/O 7 Name of school currently attending: Name of Parents/Guard:an r1 Addresal0 J Up i Street City �,�j� % �jC i_ty Home Telephone #x/ y �Cl(/`�/ ��`�ork Phone #:< Cellular Phone #: Email address: Via fax to: 305-669-4390 Gender: 11 Male �1(Y Female Grade Level for 2 How State J)i� U1Y--- 704 ou hear a • out the school? Page of Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 27 10 02:23p Vista Construction Servos 3052855844 p.1 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill out one form per student and return: Via mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: I)1?)/ fY t'J Student's Date of Bitty or Via fax to: 305-669-4390 di Gender: Male Grade Level for 2012-20 3; Name of Parents/Guardians: V) V/(211 (8er1 c it 'Y7 MeKri Address: 2r,c330 Street Home Telephone #: kA) Cellular Phone #: Email address: frerclibi /L-1)(/ )19; City Slate Zip Cade S SE k Phone #: - (74-31 -40,(1 lo Yr( Ow • C c Page 1 of 2 .1r:r 2 7 2010 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk Oct 27 10 02:23p Vista Construction Servos 3052855844 p 2 BRICKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollment Form Please fill oul one form per student and return: VIa mall to: 6361 Sunset Drive Miami, FL 33143 Student's Name: or Via lax 10: 305-669-4390 Student's Date of Birth: Narn!_of hoe) currently atter7ding: rt 1--Ma 3 Lu-)1/7-eroKi Gender: Male Grade Level for 2012-2013: Name of Parents/Guardians Vi IX) b)e Address: 4erf7rle iCay); rz Street City State Zip Code Home Telephone*: R-7-4 Work Phone #: Cellular Phone #: 44-3 VC( (.73(- Email address: VO1Prrit 10 hoc. e (»-y) Page 1 of 2 Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk 2010-10-28 14:05 TradePro 3058922884 » 3056694390 P 1/1 BR1CKELL PREPARATORY ACADEMY A tuition -free public charter school Enrollrnent Form Please fill out one_ orm per student and return: Via mail to: 6361 Sunset Drive Miami, FL 33143 Student's Last Name _Cohen_ Student's First Name _Mathias_ Gender: X Male 1] Female Student's Date of Birth: 12/t1/2007_ or Via fax to: 305-669-4390 Grade Level for zoi2-2013;_lst Name of school currently attending: La Prima Casa Montessori_ Name of Parents/Guardians: _Nancy Bibiana Reyes & Chad Cohen Address: 5zo Brickell Key Drive ;=815. Miami, FL 33131 Street City State Zip Code Home Telephone st: 305.372.1077 Work Phone ;I: _305.892.2800 ext31o7 (mom 954.893.915o (dad)_ Cellular Phone 4: _305.301.8349 (mom) 786.417,5769 (dad)_ Email address: bibinnareyescohenaDhormail.com - ccohen@fish. consulting.corrt *Your privacy is important to us, Mater Academy will not share, sell or disclose your personal information to third parties. It will only bc used to transmit information pertaining to our organization. If the school offers a bilingual prograrn, hich language would you choose? (Choose Mandarin French Italian Portugese How did you hear about the school? Neighbors at Brickell Key Submitted into the public record in connection with items PZ. 24& PZ.25 on 10-28-10 Priscilla A. Thompson City Clerk