Child’s Last Name:
Child’s First Name:
Child’s Date of Birth:
Child’s Current Grade:
Child’s Current School:
Mother’s Last Name:
Mother’s First Name:
Father’s Last Name:
Father’s First Name:
Legal Guardian’s Name:
Legal Guardian’s Cell#:
Home Phone:
Cell #:
Work #:
Home Address:
City:
Zip Code:
Mother’s Email:
Father’s Email:
Does Child have McKay?
Does Child have Step Up for Students?
Does Child have a documented disability?
How did you hear about us?
I want to enroll my Child
