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Application for Enrollment

          Date: (yyyy/mm/dd)              School Year For Application:        
Student Information
First Name:   Middle Name:   Last Name:  
Current Grade:   Entering Grade:    
Date of Birth:   (yyyy/mm/dd)   Age:   Social Security#:
Address:  
City:   State:   Zip:   County:  
Current School Information
Name:
County: State: Type:
Siblings Enrolling with Student
Name: Current Grade:
Name: Current Grade:
Name: Current Grade:
Parent/Guardian Information
Please select all that apply by holding the Ctrl key while making selections.
Who does the student live with? Other Guardian:
Contact Information
Please be sure to give the best number to reach you. If an opening is available for your child(ren), you will be notified by phone using this number or by mail at the address below. Overflow applicants are placed on a waiting list, and you will be notified if a space opens. After you have been notified, you must submit additional information (shot records and birth certificate) with in 14 days. If you do not respond within 14 days, your spot may be given to the next student on the waiting list.
Primary Contact:   Best Number to Call:  
Home: Work: Ext: Cell:
Email:  
Parent/Guardian Information
Mailing Address:
Address:   City:   State:   Zip:
Comments: