2021-2022 CCMS Registration Form

Student Name *

First

Last

Parent/Guardian Name *

First

Last

Parent/Guardian Phone Number *

Date *

Current Grade *

How many quarters would you like for your student to attend CLC: (Cannot be promised/class size, scheduling needs taken into consideration) *

Check all that apply

Parent/Guardian Signature *

183 Bobcat Trail | P.O. Box 471 Ellijay, GA 30540 | Phone: 706.635.7100 | Email: office@gilmerclc.org