SCHOOL REGISTRATION

Please show this registration form and the following documents to the school office.
• Original Certified Birth Certificate
• Original Social Security Card
• Current Immunization Form

Student Information

Name

First Name

Last Name

Birth Date

Month

Day

Year

Gender

Email Address

Phone Number

Please enter a valid phone number.

Grade

Semester

Have you previously applied to or attended this school?

Yes No

Current Residence Information

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Home Phone Number

Area Code

Phone Number