Indianapolis Junior Academy
Pre-registration form
Date
-
Month
-
Day
Year
Date
Name of Student
First Name
Last Name
Incoming Grade Level
Please Select
Pre-K
K
1
2
3
4
5
6
7
8
Grade
Date of Birth
-
Month
-
Day
Year
Date of Birth
Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender
Male
Female
Please select the kind of registration you are applying for:
New Student
Transferree
Continuing
School Transferring From
School Phone Number
Please enter a valid phone number.
Back
Next
Student (2)
Incoming Grade Level
Please Select
Pre-K
K
1
2
3
4
5
6
7
8
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender
Male
Female
Please select the kind of registration you are applying for:
New Student
Transferree
Continuing
School Transferring From
School Phone Number
Please enter a valid phone number.
Back
Next
Student (3)
Incoming Grade Level
Please Select
Pre-K
K
1
2
3
4
5
6
7
8
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender
Male
Female
Please select the kind of registration you are applying for:
New Student
Transferree
Continuing
School Transferring From
School Phone Number
Please enter a valid phone number.
Back
Next
Family Information
Name of Father
First Name
Last Name
Please check this box if deceased
deceased
Occupation
Work Phone Number
Please enter a valid phone number.
Email
example@example.com
Address (if not same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Mother
First Name
Last Name
Please check this box if deceased
deceased
Occupation
Work Phone Number
Please enter a valid phone number.
Email
example@example.com
Address (if not same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Lives With
Both Parents
Mother
Father
Appointed Legal Guardian (neither parents)
Name of Legal Guardian
First Name
Last Name
Occupation
Work Phone Number
Please enter a valid phone number.
Address (if not same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Signature of Parent/Guardian
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Submit
Submit
Should be Empty: