Student Application
2019-2020 School Year
Email address *
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 *
Student - Current School
Your answer
2019-20 School Year:
Grade Level *
Days and Time - Preschool and Pre-kindergarten Applicants only
Extended Care
Parent Information:
Parent #1 - Relationship to Applicant *
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
Parent #2 - First Name
Your answer
Parent #2 - Last Name
Your answer
Parent #2 - Mobile Phone Number
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.
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