PCMS Lottery Enrollment/Waiting List
Please complete this form if you would like to enroll your student at PCMS. If the student enrolling in PCMS has ever had a sibling who has attended PCMS in the past, please indicate below. PLEASE CONTACT THE SCHOOL by phone or email at (530) 872-7277 / jrobbins@pcms.tv TO ENSURE WE HAVE RECEIVED YOUR ENROLLMENT INFORMATION.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
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DD
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YYYY
New Family or Sibling of PCMS Alumni *
Student's Gender *
Student's Grade in the 2020-2021 School Year *
Student's Current School of Attendance *
Your answer
Student's Current School of Attendance City and State *
Your answer
Phone Number *
Please add the BEST number at which we can reach you.
Your answer
Parent Email *
Your answer
Contact Name (Parent / Guardian) *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
I certify that I have reviewed this document and to the best of my knowledge, the information contained herein is true and complete. By selecting I AGREE below, I declare under penalty of perjury that I am the parent or legal guardian of the above-named student. *
By choosing "I AGREE" and entering your name in the boxes below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
FULL NAME (Digital Signature) *
Entering your name in the boxes below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
Your answer
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