Admissions Application

Child's Full Name
Nickname
Date of Birth
MM slash DD slash YYYY
Place Of Birth
Grade Level
Gender
- Male
- Female
Are Parents Separated?
- Yes
- No
Are Parents Divorced?
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
With whom does the applicant live with:
Who is responsible for the finances:
Home Phone:
Mother's Name
First Last
Mother's Employer
Mother's Employer Phone #
Mother's Email
Name
First Last
Father's Employer
Father's Business Phone
Father's Business Fax
Father's Email
Name(s) of brother(s)
Name(s) of sister(s)
Does your child have any physical conditions which would restrict his/her activities? (if yes, describe)
Consent
$80 Application Fee (Non Refundable)
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