2021-22 School Registration

Parent Name *

Email Address *

Phone Number *

Street Address *

City *

ZIP *

Second Parent's Name

Second Parent's Email Address

Second Parent's Phone Number

Second Parent's Street Address (if different from above)

City

ZIP

Number of Students to Enroll *

Student Name

Current School

Student Date of Birth

Incoming Grade

Student Age

FINANCIAL INFORMATION

Select Your Payment Plan *

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I understand

Typed Signature *

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