Student Name
*
First Name
Last Name
Student Email
Student Phone
(###)
###
####
Student Birth Date
*
MM
DD
YYYY
Gender
*
Male
Female
Previous School
Previous Grade
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade for 2024-2025
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Parent Name
*
First Name
Last Name
Parent Email
*
Parent Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
*
First Name
Last Name
Emergency Contact's Phone
*
(###)
###
####
Does your Child have any Allergies?
*
Yes
No
If yes, to what and how severe?
Describe any social, emotional, physical or educational needs that your child may have.
Is your child on any medication?
*
Yes
No
For what purpose?
What is your cover school?
What church do you attend?
Elementary Classes
Check all that apply
Middle School Classes
Check all that apply
High School Classes
Check all that apply
Homework Help & Tutoring Classes
Check all that apply
By submitting this form to the registrar:
*
Please check each of the following boxes to indicate your agreement.