Prodigy Academy of Birmingham Enrollment Form

Student's Full Name*

First NameLast Name

Full Time EnrollmentCover School EnrollmentEnrichment Participant

Date of Birth*

Date

Grade Applying For*

MaleFemaleOther

Home Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Parent/Guardian Full Name*

First NameLast Name

Relationship to Student*

Primary Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email Address*

example@example.com

Second Parent/Guardian Full Name

First NameLast Name

Relationship to Student

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact Name*

First NameLast Name

Relationship to Student*

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Previous School Name

Previous School Address

Does the student have any allergies or medical conditions we should be aware of? If yes, please describe.

Is the student currently taking any medication? If yes, please specify.

Join Prodigy

Interest Deposit

Show your interest with our $50 fully-refundable fee. This secures your priority in rolling admissions and credits fully toward the enrollment deposit if your family chooses Prodigy. 100% refundable at any time.

$50.00 Quantity

Enrollment Deposit

Secure your child's founding class spot with our $250 fully-refundable interest deposit. This holds your place in our rolling admissions process while we finalize your custom tuition plan. Fully refundable if Prodigy isn't the right fit after your advising session.

$250.00 Quantity

Product Name

CHOOSE Act families skip the enrollment fee entirely. Email your 2025-26 CHOOSE Act approval letter and pay nothing upfront. admissions@prodigyacademyal.com

$ Free Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Afterpay

Prodigy Academy of Birmingham Enrollment Form

Student Information

Parent/Guardian Information

Additional Parent/Guardian Information (optional)

Emergency Contact Information

Previous School Information (if applicable)

Health Information

Terms and Conditions

Payment Methods