Student Enrollment

1st Take Student Enrollment

Please fill out the application below and submit when complete.

Student Information

First Name
Please choose a username.
Student Name
Date of Birth
Age
Current School
Grade
Ethnicity
Address
City
State

Parent/Legal Guardian Information #1

First Name
Last Name
Relationship
Address
City
State
Zip
Home Phone
Cell Phone

Parent/Legal Guardian Information #2

First Name
Last Name
Relationship
Address
City
State
Zip
Home Phone
Cell Phone