Enrollment Application

Date

Last Name

First Name

Middle Initial

DOB

Grade Applying For

Current School

Current Grade

Parent or Guardian 1 (relationship to student)

Parent or Guardian 1 Last Name

Parent or Guardian 1 First Name

Parent or Guardian 1 Mailing Address

Parent or Guardian 1 Home Phone

Parent or Guardian 1 Work Phone

Parent or Guardian 1 Cell Phone

Parent or Guardian 1 Email

Parent or Guardian 2 (relationship to student)

Parent or Guardian 2 Last Name

Parent or Guardian 2 First Name

Parent or Guardian 2 Mailing Address

Parent or Guardian 2 Home Phone

Parent or Guardian 2 Work Phone

Parent or Guardian 2 Cell Phone

Parent or Guardian 2 Email

With whom does the student reside?If parents/guardians are separated or divorced.

Sibling 1

Sibling 1 DOB

Sibling 2

Sibling 2 DOB

Sibling 3

Sibling 3 DOB

Parent or Guardian Signature