Application Form

Please click on the link below to download a PDF file containing our current registration application form. After completing the registration form, you may: 

  • Fax it to (561) 433-4357
  • Mail it to P.O. Box 21223, West Palm Beach, FL 33416-1223
  • Scan and email it to jmeeks@potentiaacademy.org

Potentia Academy Registration Application 2017-18