New Student Enrollment

New Student Information

Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information. * Required fields are bold.

Student 1

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeMedical InfoIndicate Program Preference

Student 2

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeMedical InfoIndicate Program Preference

Student 3

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeMedical InfoIndicate Program Preference

Student 4

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeMedical InfoIndicate Program Preference

Student 5

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeMedical InfoIndicate Program Preference

Primary Family Information

Address Line 1Address Line 2CityStateZIP CodeHome PhoneHome ListedCell PhoneCell Listed

Parent 1 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGenderRaceHome E-MailCell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 2 Information

Secondary Family Information

Address Line 1Address Line 2CityStateZIP CodeHome PhoneHome ListedCell PhoneCell Listed

Parent 3 Information

Parent 4 Information

Contact Information (Other than parents)

Contact 1

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseMobile PhonePickup TagPickup Notes

Contact 2

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseMobile PhonePickup TagPickup Notes

Contact 3

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseMobile PhonePickup TagPickup Notes

Medical Contacts

PhysicianPhysician Phone NumberDentistDentist Phone NumberHospitalHospital Phone NumberInsuranceInsurance Phone NumberPolicy Number

Finished

Confirmation E-Mail address:

Please press the save button to submit the new student application.

Date of Last Upload: Friday, January 18, 2019 Student Enrollment Form

Student 1

Primary Family Information

Parent 1 Information

Parent 2 Information

Secondary Family Information

Parent 3 Information

Parent 4 Information

Contact Information (Other than parents)

Contact 1

Medical Contacts