Date of Last Upload:
Thursday, February 27, 2020
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
Suffix
<None>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
E-Mail
*
Grade Level
<None>
Ducklings I
Ducklings II
Penguins
Turtles
Lambs
PS
PS II
PS+
PK3
PK4
K
1
2
3
4
5
6
7
8
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 2
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Suffix
<None>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
E-Mail
*
Grade Level
<None>
Ducklings I
Ducklings II
Penguins
Turtles
Lambs
PS
PS II
PS+
PK3
PK4
K
1
2
3
4
5
6
7
8
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 3
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Suffix
<None>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
E-Mail
*
Grade Level
<None>
Ducklings I
Ducklings II
Penguins
Turtles
Lambs
PS
PS II
PS+
PK3
PK4
K
1
2
3
4
5
6
7
8
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 4
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Suffix
<None>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
E-Mail
*
Grade Level
<None>
Ducklings I
Ducklings II
Penguins
Turtles
Lambs
PS
PS II
PS+
PK3
PK4
K
1
2
3
4
5
6
7
8
Blood Type
<None>
A+
A-
AB+
AB-
B+
B-
O+
O-
Student 5
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
Suffix
<None>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
E-Mail
*
Grade Level
<None>
Ducklings I
Ducklings II
Penguins
Turtles
Lambs
PS
PS II
PS+
PK3
PK4
K
1
2
3
4
5
6
7
8
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>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
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>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
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>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
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>
III
Jr.
IV
Title
<None>
Dr.
Miss
Mr.
Mrs.
Ms.
Rev.
Church Affiliation
<None>
AEC Member
AME
Anglican
Baptist
Buddhist
Buddism
Catholic
Christian
Christian Orthodox
Christian/Hindu
Episcopalian
Greek Orthodox
Hindu
Iranian
Jewish
Lutheran
Methodist
Muslim
Non Denominational
Orthodox Christian
Pentecostal
Presbyterian
Protestant
Protestant - Baptist
Roman Catholic
Seventh Day Adventist
Gender
<None>
Female
Male
Race
<None>
African American
African/Nigerian
American Indian
American/Hispanic
Armenian/Caucasian
Asian
Asian American
Asian Indian
Asian/Caucasian
Asian/Hispanic
Biracial
Black
Black/White
Caucasian
Chinese
Chinese/Caucasian
Chinese/Korean
German/Indian
Greek/Asian
Hispanic
Hispanic/Caucasian
Hispanic/Indian
Indian
Indian/South Asian
Korean
Korean/Filipino
Native American
Other
Vietnamese
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
Niece
Daughter
Son
Cousin
Mother-In-Law
Sister-In-Law
Parents
Friend/Neighbor
Fiance
Daughter-In-Law
Nanny
Godmother
Half-Sister
Step Grandparent
Dad's Girlfriend
Mother's Aunt
Step Mother
Step-Father
Foster Mother
Foster Dad
Foster Mom
Godfater
Godfather
Sitter
Great Aunt / Great Uncle
Great Aunt
Guardian
In-Law
Partner
Babysitter
Grandchild
Pastor
Great Grandparent
Nephew
Neighbor
Boy Friend
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
Niece
Daughter
Son
Cousin
Mother-In-Law
Sister-In-Law
Parents
Friend/Neighbor
Fiance
Daughter-In-Law
Nanny
Godmother
Half-Sister
Step Grandparent
Dad's Girlfriend
Mother's Aunt
Step Mother
Step-Father
Foster Mother
Foster Dad
Foster Mom
Godfater
Godfather
Sitter
Great Aunt / Great Uncle
Great Aunt
Guardian
In-Law
Partner
Babysitter
Grandchild
Pastor
Great Grandparent
Nephew
Neighbor
Boy Friend
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
Niece
Daughter
Son
Cousin
Mother-In-Law
Sister-In-Law
Parents
Friend/Neighbor
Fiance
Daughter-In-Law
Nanny
Godmother
Half-Sister
Step Grandparent
Dad's Girlfriend
Mother's Aunt
Step Mother
Step-Father
Foster Mother
Foster Dad
Foster Mom
Godfater
Godfather
Sitter
Great Aunt / Great Uncle
Great Aunt
Guardian
In-Law
Partner
Babysitter
Grandchild
Pastor
Great Grandparent
Nephew
Neighbor
Boy Friend
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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