GEM School Registration Form
Admission is subject to confirmation after the parent and student interview.
Registering for:
*
2026 - 2027 Academic Year
1 - Student's Full Name
*
First Name
Last Name
Student Email
*
example@example.com
2 - Student's Date of Birth
*
-
Month
-
Day
Year
Date of Birth
3 - Grade Level (2026-2027)
*
Please Select
K
1
2
3
4
5
6
7
8
9
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Add Parents' Info
PARENT INFORMATION
Mother Full Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father Full Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Secure Spot
PAYMENT
Save your child's spot
*
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next
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Application Fee
Non Refundable
$150.00
$
150.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Any Comments
Enrollment Agreement
Please review and sign
*
Signature
*
Date of Consent
*
/
Month
/
Day
Year
Date
How did you hear about this program
*
Facebook
Email
Whatsapp
Instagram
Friend
Back to School Fair
Representative called
Received postcard
GEM Newsletter
Other
Submit
Should be Empty: