Date of Last Upload: Tuesday, March 28, 2023 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 NameMiddle NamePreferred NameSuffix*Gender at Birth*Race*Date of Birth*RELIGIONChurch ParishPublic School District*Grade Level

Last School Attended & Grade

Student 2

*Last Name*First NameMiddle NamePreferred NameSuffix*Gender at Birth*Race*Date of Birth*RELIGIONChurch ParishPublic School District*Grade Level

Last School Attended & Grade

Student 3

*Last Name*First NameMiddle NamePreferred NameSuffix*Gender at Birth*Race*Date of Birth*RELIGIONChurch ParishPublic School District*Grade Level

Last School Attended & Grade

Student 4

*Last Name*First NameMiddle NamePreferred NameSuffix*Gender at Birth*Race*Date of Birth*RELIGIONChurch ParishPublic School District*Grade Level

Last School Attended & Grade

Student 5

*Last Name*First NameMiddle NamePreferred NameSuffix*Gender at Birth*Race*Date of Birth*RELIGIONChurch ParishPublic School District*Grade Level

Last School Attended & Grade

Primary Family Information

*Address Line 1Address Line 2*City*State*ZIP CodeHome PhoneHome ListedCell PhoneCell Listed

Parent 1 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGender at BirthRace*Home E-Mail*Cell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 2 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGender at BirthRace*Home E-Mail*Cell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Secondary Family Information

*Address Line 1Address Line 2*City*State*ZIP CodeHome PhoneHome ListedCell PhoneCell Listed

Parent 3 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGender at BirthRace*Home E-Mail*Cell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 4 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGender at BirthRace*Home E-Mail*Cell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Contact Information (Other than parents)

Contact 1

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

Contact 2

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

Contact 3

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

Medical Contacts

Finished

Confirmation E-Mail address:

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