Date of Last Upload:
Sunday, February 25, 2024
Student Enrollment Form
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's Information
Primary Family Information
Secondary Family Information
Contact Information
Submit Application
Student 1
*
Last Name
*
First Name
Middle Name
Preferred Name
*
Date of Birth or Due Date (mm/dd/yyyy)
Suffix
<None>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
*
E-Mail
*
Grade Level
<None>
Ducklings
Angels
Owls
Teddy Bears
Little Fish
Busy Bees
Peacocks
Kittens
Dalmatians
Camp S'more
Expecting
Adopting
1yr.old
Infant
Younger 2's
Older 2's
Changed Mind
Pre-k 3
Pre-k 4
Administration
Floater
Do Not Transfer
Summer Student
Drop ins
*
Prospective Start (mm/dd/yyyy)
Student 2
*
Last Name
*
First Name
Middle Name
Preferred Name
*
Date of Birth or Due Date (mm/dd/yyyy)
Suffix
<None>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
*
E-Mail
*
Grade Level
<None>
Ducklings
Angels
Owls
Teddy Bears
Little Fish
Busy Bees
Peacocks
Kittens
Dalmatians
Camp S'more
Expecting
Adopting
1yr.old
Infant
Younger 2's
Older 2's
Changed Mind
Pre-k 3
Pre-k 4
Administration
Floater
Do Not Transfer
Summer Student
Drop ins
*
Prospective Start (mm/dd/yyyy)
Student 3
*
Last Name
*
First Name
Middle Name
Preferred Name
*
Date of Birth or Due Date (mm/dd/yyyy)
Suffix
<None>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
*
E-Mail
*
Grade Level
<None>
Ducklings
Angels
Owls
Teddy Bears
Little Fish
Busy Bees
Peacocks
Kittens
Dalmatians
Camp S'more
Expecting
Adopting
1yr.old
Infant
Younger 2's
Older 2's
Changed Mind
Pre-k 3
Pre-k 4
Administration
Floater
Do Not Transfer
Summer Student
Drop ins
*
Prospective Start (mm/dd/yyyy)
Student 4
*
Last Name
*
First Name
Middle Name
Preferred Name
*
Date of Birth or Due Date (mm/dd/yyyy)
Suffix
<None>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
*
E-Mail
*
Grade Level
<None>
Ducklings
Angels
Owls
Teddy Bears
Little Fish
Busy Bees
Peacocks
Kittens
Dalmatians
Camp S'more
Expecting
Adopting
1yr.old
Infant
Younger 2's
Older 2's
Changed Mind
Pre-k 3
Pre-k 4
Administration
Floater
Do Not Transfer
Summer Student
Drop ins
*
Prospective Start (mm/dd/yyyy)
Student 5
*
Last Name
*
First Name
Middle Name
Preferred Name
*
Date of Birth or Due Date (mm/dd/yyyy)
Suffix
<None>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
*
E-Mail
*
Grade Level
<None>
Ducklings
Angels
Owls
Teddy Bears
Little Fish
Busy Bees
Peacocks
Kittens
Dalmatians
Camp S'more
Expecting
Adopting
1yr.old
Infant
Younger 2's
Older 2's
Changed Mind
Pre-k 3
Pre-k 4
Administration
Floater
Do Not Transfer
Summer Student
Drop ins
*
Prospective Start (mm/dd/yyyy)
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>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
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>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
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>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
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>
JR
II
III
Sr.
SR
V
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
Alumni Family
Baptist
Catholic
Church of England
Episcopalian
Former Parent
Holy Name
Jewish
Methodist
Non-Denominational
Rayne
Sibling
St Joseph Baptist Church
St.Francis of Assisi
Staff
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Asian/Caucasian
Caucasian
Cuban
Hispanic
Indian
Latin
Mixed
Multiracial
Native American
White
White/Asian Indian
White/Hispanic
White/Latina
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
Daughter
Cousin
Parents
God Mother
Fiance
son
Mother-in-law
Family
Daughter-in-law
In-Laws
Friend/co-worker
Brother-in-law
Nanny
Niece
Babysitter
Family Friend
Nephew
Grandchild
Godchild
God Father
Neighbor
Great Aunt
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
Daughter
Cousin
Parents
God Mother
Fiance
son
Mother-in-law
Family
Daughter-in-law
In-Laws
Friend/co-worker
Brother-in-law
Nanny
Niece
Babysitter
Family Friend
Nephew
Grandchild
Godchild
God Father
Neighbor
Great Aunt
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
Daughter
Cousin
Parents
God Mother
Fiance
son
Mother-in-law
Family
Daughter-in-law
In-Laws
Friend/co-worker
Brother-in-law
Nanny
Niece
Babysitter
Family Friend
Nephew
Grandchild
Godchild
God Father
Neighbor
Great Aunt
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
Confirmation E-Mail address:
Please press the save button to submit the new student application.