Online Pre-Enrollment Form

*Required Fields

STUDENT INFORMATION
*Student Name:
Sex:	Select Male Female
Birthdate (mm/dd/yy):
*School year:	Select 2009-2010 2010-2011
*Grade Interested in:	Select K 1 2 3 4 5 6 7 8
Current School:
Is the sibling of the applicant currently attending this school?
	no yes
If yes, please provide student's name:
If a sibling will be pre-enrolling as well, please provide the following information:
Sibling Name:
Sex:	Select Male Female
Birthdate (mm/dd/yy):
School year:	Select 2009-2010 2010-2011
Grade Interested in:	Select K 1 2 3 4 5 6 7 8
Current School:
Second Sibling Name:
Sex:	Select Male Female
Birthdate (mm/dd/yy):
School year:	Select 2009-2010 2010-2011
Grade Interested in:	Select K 1 2 3 4 5 6 7 8
Current School:
PARENT/GUARDIAN CONTACT INFORMATION:
Salutation:	Select Ms Mrs Miss
Mother First Name:
Mother Last Name:
Salutation:	Select Mr
Father First Name:
Father Last Name:
*Address 1:
Address 2:
*City:
*State:	Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC NE NH NJ NM NS NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
*Zip:
*Home Phone:
*Work Phone:
Mobile Phone:
*Email Address:
Preferred contact method?	Email Phone Postal Mail
*How did you learn about our school?
Enter your email address here if you would like to receive a confirmation email:
Enrollment is based upon a space-available basis. You will be contacted Feburary 22 regarding your enrollment status.