Name *

First Name

Last Name

Student Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

In which semester is the student applying?

Spring 2024

2024-25 School Year

In what grade level is the student applying? *

Pre-K

Kindergarten

1st

2nd

3rd

4th

5th

6th

7th

8th

Has the student been homeschooled? *

Yes

No

Has the student attended any other schools? *

Yes

No

Has the student ever had counseling from a family counselor, psychologist, psychiatrist? *

Yes

No

Parent/Guardian 1 *

First Name

Last Name

Gender *

Male

Female

Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Custodial Rights? *

Yes

No

Receive Correspondence? *

Yes

No

Parent/Guardian 2 *

First Name

Last Name

Gender *

Male

Female

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Custodial Rights?

Yes

No

Receive Correspondence?

Yes

No

Emergency Contact 1 *

First Name

Last Name

Phone

(###)

###

####

Emergency Contact 2

First Name

Last Name

Phone

(###)

###

####

Emergency Contact 3

First Name

Last Name

Phone

(###)

###

####

Emergency Contact 4

First Name

Last Name

Phone

(###)

###

####

Student Information *

By checking the box below, you are indicating that all information provided in the student application is correct.

Yes

No

Mission Statement and Student Handbook *

By checking the box below, you are signing this agreement that you have read the mission statement and student handbook. Your signature further indicates that you agree with the school's philosophy and agree to follow the school's rules and guidelines.

Yes

No

Date *

MM

DD

YYYY