Date of Last Upload:
Thursday, September 28, 2023
Student Enrollment Form
New Student Information
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*
Required fields are bold.
Student's Information
Primary Family Information
Secondary Family Information
Contact Information
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Student 1
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
E-Mail
*
Grade Level
<None>
K
K4
K5
1
2
3
4
5
6
7
8
1 - 2
2-3
6/7
7/8
Computer/Stem/Physical Ed.
5-8 Mathematics
5-6
4-5
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 2
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
E-Mail
*
Grade Level
<None>
K
K4
K5
1
2
3
4
5
6
7
8
1 - 2
2-3
6/7
7/8
Computer/Stem/Physical Ed.
5-8 Mathematics
5-6
4-5
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 3
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
E-Mail
*
Grade Level
<None>
K
K4
K5
1
2
3
4
5
6
7
8
1 - 2
2-3
6/7
7/8
Computer/Stem/Physical Ed.
5-8 Mathematics
5-6
4-5
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 4
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
E-Mail
*
Grade Level
<None>
K
K4
K5
1
2
3
4
5
6
7
8
1 - 2
2-3
6/7
7/8
Computer/Stem/Physical Ed.
5-8 Mathematics
5-6
4-5
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 5
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
E-Mail
*
Grade Level
<None>
K
K4
K5
1
2
3
4
5
6
7
8
1 - 2
2-3
6/7
7/8
Computer/Stem/Physical Ed.
5-8 Mathematics
5-6
4-5
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Primary Family Information
Address Line 1
Address Line 2
City
State
ZIP Code
Home Phone
Home Listed
Cell Phone
Cell Listed
Parent 1 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Grandma
III
Jr.
Senior
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Mrs
Ms
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
Home E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Parent 2 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Grandma
III
Jr.
Senior
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Mrs
Ms
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
Home E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Secondary Family Information
Address Line 1
Address Line 2
City
State
ZIP Code
Home Phone
Home Listed
Cell Phone
Cell Listed
Parent 3 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Grandma
III
Jr.
Senior
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Mrs
Ms
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
Home E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Parent 4 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Marital Status
<None>
Divorced
Engaged
Married
Separated
Single
Widow
Widower
Suffix
<None>
Grandma
III
Jr.
Senior
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Mrs
Ms
Church Affiliation
<None>
Action In Christ
ACTS Christian Church
Arbol del Vida
BRCC
Brooklyn Tabernacle
Catholic
Cherubim and Seraphim Pen
Christ Methodist Church
Christ uncensored House
Church @ The Rock
Church of the Redemeer
Coney Island Fellowship B
Coptic Orthodox Church of
ECMSI
Elohim
Evangelical Church of God
Familia de Juda
First Evangelical Free
Fraternidad Cristiana Sta
Good News Mission
Horizon Christian Fellows
House of Prayer
House of Restoration
ICC - Staten Island
Iglesia de Dios Pentecost
Iglesia del Redentor
Iglesia El Buen Pastor CL
Iglesia Misionera Jovenes
Iglesia Pent Agape
Iglesia Pent de Jerico
Iglesia Pent El Verbo
Iglesia Pent Fuente Divin
Jovenes Cristianos
Lefferts Park Baptist
Manhattan Grace Tabernacl
New Creation Internationa
New Wine Fresh Fire
Park Slope Christian
Pentecostal Assembly
Pilgrim Wslaynn Church
Primitive Christian Churc
Principe de Paz
Resurrection Church
Russian Orthodox
Saint Gregory
Saint Michael
Salem Church
Salvation Army
Sol De Justicia
St. Patricks
Tabernaculo de Jehova
Templo Cristiano de Bklyn
Templo De La Alabanza
The House Church
The Rescue Church
Times Square Church
Trinity Tabernacle of Gra
Two River Church
Victory Outreach
WHCC
Zion NYC
Gender
<None>
Female
Male
Race
<None>
African American
American
Arabic
Asian
Caucasian
Chinese
Egyptian
Hispanic
Indian
mixed
Muslim
Native American
Russian
Home E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Business E-Mail
Is Allowed to Pickup
Contact Information (Other than parents)
Contact 1
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Cousin
Step Dad
Godmother
Babysitter
Stepmother
Brother-In-Law
Sister-In-Law
Nephew
Godfather
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
Cell Phone
Pickup Tag
Pickup Notes
Contact 2
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Cousin
Step Dad
Godmother
Babysitter
Stepmother
Brother-In-Law
Sister-In-Law
Nephew
Godfather
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
Cell Phone
Pickup Tag
Pickup Notes
Contact 3
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Cousin
Step Dad
Godmother
Babysitter
Stepmother
Brother-In-Law
Sister-In-Law
Nephew
Godfather
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
Cell Phone
Pickup Tag
Pickup Notes
Medical Contacts
Physician
Physician Phone Number
Dentist
Dentist Phone Number
Hospital
Hospital Phone Number
Insurance
Insurance Phone Number
Policy Number
Finished
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