Student Registration

Student Information

Legal First Name*

Answer required for "Legal First Name"

Legal Middle Name

Answer required for "Legal Middle Name"

Legal Last Name*

Answer required for "Legal Last Name"

Preferred Name

Answer required for "Preferred Name"

Date of Birth*

Answer required for "Date of Birth"

First language spoken by student*

Answer required for "First language spoken by student"

Languages spoken at home*

Answer required for "Languages spoken at home"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone*

Number Required

Last school attended

Name of school

Answer required for "Name of school"

Dates attended

Answer required for "Dates attended"

School phone number

Number Required

City, State

Answer required for "City, State"

Reason for leaving

Answer required for "Reason for leaving"

Parent/Guardian 1 Information

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Relationship to student:*

Answer required for "Relationship to student:"

Email*

Answer required for "Email"

Same address as student?*

Answer required for "Same address as student?"

Yes

If no, please list address:

Answer required for "If no, please list address:"

Mobile Phone*

Number Required

Work Phone

Number Required

Parent/Guardian 2 Information

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Relationship to student:

Answer required for "Relationship to student:"

Question

Answer required for "Question"

Same address as student?

Answer required for "Same address as student?"

Yes

If no, please list address:

Answer required for "If no, please list address:"

Mobile Phone

Number Required

Work Phone

Number Required

Sibling Information

Please list any other siblings/children living at the same address as student. Include Full name, sex, relationship to parent, school attending

Answer required for "Please list any other siblings/children living at the same address as student. Include Full name, sex, relationship to parent, school attending"

Please fix the highlighted areas below before submitting.

Student Registration