Application for Student Re-enrollment

Application for Student Re-enrollment
Student Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate*

MonthDayYear
Date
Current Grade*
Parent Information
Father's Name*

First NameLast Name
Father's Email*
example@example.com
Father's Phone Number*
Please enter a valid phone number.
Mother's Name*

First NameLast Name
Mother's Email*
example@example.com
Mother's Phone Number*
Please enter a valid phone number.
Marital Status*

SingleMarriedWidowedDivorced
Church Information
Church Attenting*
Pastor's Name*

First NameLast Name
Church Phone Number*
Please enter a valid phone number.
Re-Enrollment Fee of $200 per child will be billed to the final tuition statement of the current year.
Should be Empty:

Student Information