Enrollment Application

Student Registration Form

To register for the school year please complete all fields.
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Student Social Security Number*
Name of Previous School
Entering Grade*
Student Ethnicity
Male/Female?*

MaleFemale
Student lives with
Name
Relationship to Student
Person Responsible for Tuition
Please enter full name and phone number.
Student Address*

Street Address

Apartment/Unit (if applicable)

CityState

Zip Code

Student Registration Form