Enrollment Application

Date

MonthDayYear
Date
Incoming Grade Level
Session*

Morning SessionAfternoon Session
Name of Student

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender

MaleFemale
Ethnicity
Is the applicant child bilingual/multi-lingual?

YesNo
Please Specify the Languages Spoken
Primary Language Spoken at Home
Please select the kind of registration you are applying for:

New StudentTransferreeContinuing
School Transferring From
School Phone Number
Please enter a valid phone number.
Upload a digital copy/photo of the transcript or report card

Note: you might eventually be required to submit a physical hardcopy of this document
Cancelof

Family Information
Name of Father

First NameLast Name
Please check this box if deceased

deceased
Occupation
Work Phone Number
Please enter a valid phone number.
Address (if not same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Mother

First NameLast Name
Please check this box if deceased

deceased
Occupation
Work Phone Number
Please enter a valid phone number.
Address (if not same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Siblings
Student Lives With

Both ParentsMotherFatherAppointed Legal Guardian (neither parents)
Name of Legal Guardian

First NameLast Name
Occupation
Work Phone Number
Please enter a valid phone number.
Address (if not same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Medical and Health Information
Is your child taking any medications at home or at school?

YesNo
Please provide details
Does your Child have any allergies to any of the following: Insect Bites, Food, Seasonal Allergies, Latex, Medicine, etc.

YesNo
Please provide details