Date of Last Upload:
Monday, October 24, 2022
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
Goes By Name
Date of Birth
Suffix
<None>
Jr.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
E-Mail
*
Grade Level
<None>
Kindergarten (3 yr)
Kindergarten (4 yr)
Kindergarten (5 yr)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
Student 2
*
Last Name
*
First Name
*
Middle Name
Goes By Name
Date of Birth
Suffix
<None>
Jr.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
E-Mail
*
Grade Level
<None>
Kindergarten (3 yr)
Kindergarten (4 yr)
Kindergarten (5 yr)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
Student 3
*
Last Name
*
First Name
*
Middle Name
Goes By Name
Date of Birth
Suffix
<None>
Jr.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
E-Mail
*
Grade Level
<None>
Kindergarten (3 yr)
Kindergarten (4 yr)
Kindergarten (5 yr)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
Student 4
*
Last Name
*
First Name
*
Middle Name
Goes By Name
Date of Birth
Suffix
<None>
Jr.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
E-Mail
*
Grade Level
<None>
Kindergarten (3 yr)
Kindergarten (4 yr)
Kindergarten (5 yr)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
Student 5
*
Last Name
*
First Name
*
Middle Name
Goes By Name
Date of Birth
Suffix
<None>
Jr.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
E-Mail
*
Grade Level
<None>
Kindergarten (3 yr)
Kindergarten (4 yr)
Kindergarten (5 yr)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
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.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
Primary E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Alternate 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.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
Primary E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Alternate 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.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
Primary E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Alternate 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.
Sr.
III
IV
V
Title
<None>
Mr.
Mrs.
Miss
Dr.
Rev.
(none)
Ms.
Gender
<None>
Female
Male
Race
<None>
African American
Arab
Asian
Asian-Indian
Bi-racial
Caucasian
Hispanic
Indian
Korean American
Native American
Primary E-Mail
Cell Phone
Cell Listed
Company Name
Business Phone
Extension
Job Title
Is Emergency Contact
Alternate 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
Grandfather
Grandmother
Neighbor
Step-father
Step-mother
Foster Parent
Guardian
Cousin
great-grandfather
great-aunt
great grandmother
grand 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
Grandfather
Grandmother
Neighbor
Step-father
Step-mother
Foster Parent
Guardian
Cousin
great-grandfather
great-aunt
great grandmother
grand 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
Grandfather
Grandmother
Neighbor
Step-father
Step-mother
Foster Parent
Guardian
Cousin
great-grandfather
great-aunt
great grandmother
grand 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:
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