Online Pre-Registration
Full Name of Student*
Gender*
 Male
 Female
Student's Birthdate*
Student's Home Address*
City*
Zip Code*
Home Phone*
Current School*
Grade*
Parent/Legal Guardian (Full Name)*
Other Parent/Legal Guardian (Full Name)*
E-mail Address*
Other E-mail Address
Cell Phone
Other Cell Phone
Address (if different from child)
Parent/Legal Guardian Employment*
Other Parent/Legal Guardian Employment
Special Medical Considerations
Brothers and Sisters (Full Name, Gender, Age, and Grade)
E-Signature of Parent/Legal Guardian (First + Last Name)*
Questions or Comments


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Start children off on the way they should go, and even when they are old they will not turn from it. ~ Proverbs 22:6