New Student Application
Student Info:
Student Name
*
First Name
Last Name
Birthdate
Parent/Guardian
*
First Name
Last Name
Parent/Guardian
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number 1
*
Format: (000) 000-0000.
Phone Number 2
*
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please describe your students educational experience so far.
We offer two-day and four-day enrollments. Friday are an optional drop in, available to all students. Which days would you like for your student to attend WLC?
Monday
Tuesday
Wednesday
Thursday
Friday
Does your student take any medications, or have any allergies or medical conditions we should be aware of?
Do you agree to read the WLC Handbook (found on our website) and abide by the policies contained therein?
Yes
Please sign to verify that the information in this form is true and correct.
Thank you!
We will be in touch after reviewing your application!
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