ENROLLMENT APPLICATION
CHILD's INFORMATION:
First Name:
*
Last Name:
*
Date of Birth:
*
-
Month
-
Day
Year
Date Picker Icon
Home Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Gender:
Male
Female
Phone Number
*
-
Area Code
Phone Number
Name of School:
Grade:
*
Grade Pre-K
Grade K
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
How did you hear about us:
PARENT's INFORMATION:
Mother's First Name:
*
Last Name:
*
E-mail Address:
Phone Number:
*
-
Area Code
Phone Number
Father's First Name:
*
Last Name:
*
E-mail Address:
Phone Number:
*
-
Area Code
Phone Number
OPTIONS:
PreSchool:
2 Days
3 Days
4 Days
After School:
1 day
2 days
3 days
4 days
5 days
PickUp from School:
Yes
No
Addons:
Behnaz Art
Bhangra Sports Academy
SpeakDebate
Young Engineers
Math Using Beads
EMERGENCY CONTACT:
First Name:
Last Name:
Relation:
Phone Number
-
Area Code
Phone Number
Press Register to Pay:
*
prev
next
( X )
New Student Enrollment
$
150.00
Register and Pay
Should be Empty: