Student Application
2021-2022 School Year
* Required
Email address
*
Your email
Student Information:
Student - First Name
*
Your answer
Student - Last Name
*
Your answer
Student - Nickname
Your answer
Student - Date of Birth
*
MM
/
DD
/
YYYY
Student - Gender
*
Boy
Girl
Student - Current School
Your answer
2021-22 School Year:
Grade Level
*
Toddler (two years old before August 1, 2021)
Preschool (three years old before August 1, 2021 and potty-trained)
Pre-kindergarten (four years old before August 1, 2021 and potty-trained)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Days and Time - Toddler, Preschool, and Pre-kindergarten Applicants only (not K-6)
5 Full Days (Mon - Fri)
4 Full Days (Mon - Thurs or Tues - Fri)
3 Full Days (Mon, Wed, Fri)
2 Full Days (Tues, Thurs)
5 Mornings (Mon - Fri)
4 Mornings (Mon - Thurs or Tues - Fri)
3 Mornings (Mon, Wed, Fri)
2 Mornings (Tues, Thurs)
Clear selection
Extended Care
Afternoon Extended Care (3:30 pm - 5:30 pm)
No extended Care
Clear selection
Parent Information:
Parent #1 - Relationship to Applicant
*
Mother
Father
Guardian
Parent #1 - First Name
*
Your answer
Parent #1 - Last Name
*
Your answer
Parent #1 - Mobile Phone Number
*
Your answer
Parent #1 - Home Street Address
*
Your answer
Parent #1 - City
*
Your answer
Parent #1 - State
*
Your answer
Parent #1 - Zip Code
*
Your answer
Parent #2 - Relationship to Applicant
Mother
Father
Guardian
Clear selection
Parent #2 - First Name
Your answer
Parent #2 - Last Name
Your answer
Parent #2 - Mobile Phone Number
Your answer
Parent #2 - Email
Your answer
Parent #2 - Home Street Address (if not same as Parent #1)
Your answer
Parent #2 - City
Your answer
Parent #2 - State
Your answer
Parent #2 - Zip
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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