Piedmont Classical High School Enrollment Application
2018-2019
Email address *
Untitled Title
What grade are you applying for? *
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Student's Birthday *
MM
/
DD
/
YYYY
Street Address *
Your answer
Apartment #
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Mailing Address, if different than above
Street Address
Your answer
Apartment #
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Telephone *
Your answer
Primary E-Mail *
Your answer
County of Residence *
Your answer
Do you have a student currently attending PCHS? *
If yes, what is the student's name:
Your answer
Student's Grade:
Are you or any other guardian a staff member? *
If yes, please indicate his/her name:
Your answer
Are you or any other Guardian a Board Member? *
If yes, please indicate his/her name:
Your answer
Parent/Guardian #1 Information
Name
Your answer
Parent/Guardian #1 Information *
Relationship
Your answer
Parent/Guardian #1 Information *
Street Address
Your answer
Parent/Guardian #1 Information *
City
Your answer
Parent/Guardian #1 Information *
State
Your answer
Parent/Guardian #1 Information *
Zip Code
Your answer
Parent/Guardian #1 Information *
E-Mail
Your answer
Parent/Guardian #1 Information *
Phone #
Your answer
Parent/Guardian #2 Information
Name
Your answer
Parent/Guardian #2 Information
Relationship to student
Your answer
Parent/Guardian #2 Information
Street Address
Your answer
Parent/Guardian #2 Information
City
Your answer
Parent/Guardian #2 Information
State
Your answer
Parent/Guardian #2 Information
Zip Code
Your answer
Parent/Guardian #2 Information
Phone #
Your answer
Parent/Guardian #2 Information
E-Mail
Your answer
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