Student's First Name *

Preferred Name

Student's Last Name*

Please select the school year you are interested in:
Select...2024/20252025/20262026/20272027/2028

Grade Entering in the Selected Year*
Select...KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth Grade

Gender*

Date of Birth*

Current School*

Siblings' Names, Ages, and Current Schools (or N/A if not applicable)*

Parent 1 Title

Parent 1 First Name*

Parent 1 Last Name*

Relationship to Child*

Parent 1 Address*

Parent 1 City*

Parent 1 State*

Parent 1 Zip Code*

Parent 1 Cell Number*

Parent 1 Email*