Application for Student Enrollment in vertical collapsible tabs



Student Information
Last Name
First Name
Middle Name

Preferred First Name
Date of Birth
Gender

Home Phone
Cell Phone
Email

Residential Address Line 1
Residential Address Line 2

City/Town
State/Province/Region

Zip/Postal Code
Country

Citizenship
Primary Language
English
Other:

Grade Level of Entry
School Year of Entry

Current School Information
Current School Name
Current Grade

School Address Line 1
School Address Line 2

City/Town
State/Province/Region

Zip/Postal Code
Country

Parent/Guardian Information
Parent/Guardian 1

Title
First Name
Last Name

Relationship to Student
Marital Status

Primary Language
English
Other:
Does the student live with you?
Yes
No




Home Phone
Work Phone

Cell Phone
Email

Employer
Occupation


Parent/Guardian 2

Title
First Name
Last Name

Relationship to Student
Marital Status

Primary Language
English
Other:
Does the student live with you?
Yes
No




Home Phone
Work Phone

Cell Phone
Email

Employer
Occupation

Emergency Contact
Emergency Contact 1

First Name
Last Name

Relationship to Student
Phone Number


Emergency Contact 2

First Name
Last Name

Relationship to Student
Phone Number

Signature
We certify that the information provided in this form is true and correct.

Parent/Guardian 1 Signature
Parent/Guardian 2 Signature

Application Fee
The application fee must be paid and it is non-refundable.

Please select the relevant fee:
$50 for domestic applicant
$100.00 for international applicant