Preliminary Registration

Preliminary Registration Form

Completion of this form holds your spot for registration, however a physical copy of the registration packet will need to be completed and returned to the office.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Grade
Grade
Additional Student Names, Birth Dates, Genders, and Grades
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different than home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Church/ Religious Affiliation
Additional Comments
Should be Empty:

Preliminary Registration Form