Registration

Student Name *

First

Last

Student Date Of Birth *

Student Gender *

Student Address *

Address Line 1

Address Line 2

City

State

Zip Code

Last School Attended

Last Grade Completed

Grade Level 2025/2026 *

Has Student Ever Repeated a grade

Does Student Require Special Services *

Does your child have any medical problems of which the school should be aware? *

Other Medical Issues

Languages Spoken

Parent Information

Father's/Gaurdian Name *

First

Last

Father's Phone *

Father's Email *

Mothers/Gaurdian Name *

First

Last

Mother's Phone *

Mother's Email *

Emergency Contact and Pick-Up Authorization

Emergency Contact 1 Name

Emergency Contact 1 Relation to Child

Emergency Contact 1 Phone

Can Emergency Contact 1 Pickup?

Emergency Contact 2 Name

Emergency Contact 2 Relation to Child

Emergency Contact 2 Phone

Can Emergency Contact 2 Pickup?

Medical Information

Students Physician Name

Student Physician Address

Address Line 1

Address Line 2

City

State

Zip Code

Student Physician Phone

Additional Documents

Click or drag a file to this area to upload.

Upload documents stated in the admission packet

Parent Information

Emergency Contact and Pick-Up Authorization

Medical Information

School Hours