Today’s Date

Date Classes Begin

Grade in which student is enrolling

Student’s Full Legal Name – Last, First, Middle

Student’s Nickname, if applicable

Student’s Physical Address (no PO Boxes)

Student’s Mailing Address, if different

Student’s Date of Birth

Place of Birth: City, State, Country

Student’s Sex

Student’s Race*

Student’s Home Telephone Number

Parent’s Email Address

Mother’s Legal Name – Last, First, Middle

Father’s Legal Name – Last, First, Middle

Mother’s Address, if different from student

Father’s Address, if different from student

Mother’s Daytime Telephone Number

Father’s Daytime Telephone Number

Church Name, if applicable

Church Address, if applicable

Name of Last School Attended, if applicable

Address of Last School Attended, if applicable

Last Grade Completed at Above School

Date of Attendance at Above School

Circle Desired Reporting Option:

ANNUAL          BI-ANNUAL (twice a year)

Circle Desired Payment Option – Payment due at time of registration and should be included unless paid via Paypal. 

CHECK     MONEY ORDER     PAYPAL

High School Students Only:

Student’s Social Security Number

Parent’s Driver’s License Number – if paying by check