Enrollment Form

Student Information

Student Full Name *

Date of Birth *

Gender

Grade Applying For *

Home Address *

City *

State *

ZIP Code *

Primary Language Spoken at Home

Is the Student an English Language Learner?

YesNo

Parent/Guardian 1 Full Name *

Relationship to Student *

Parent/Guardian 1 Phone *

Parent/Guardian 1 Email *

Parent/Guardian 2 Full Name

Relationship to Student

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

Emergency Contact Name *

Relationship to Student

Emergency Contact Phone *

Previous School Attended

Does the Student Have an IEP or 504 Plan?

YesNo

Allergies or Medical Conditions

Additional Comments

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