Student's First Name*

	Student's Last Name*

	Gender of Student
		Female Male

	Title of Parent/Guardian

	Parent/Guardian's First Name*

	Parent/Guardian's Last Name*

	Relationship to student *

	Street Address *

	City*

	State*
		- select - AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Other

	Zip Code*

	Phone Type
		- select - Home Business Cellular Temporary

	Phone Number

	Email Address*

	Students Birthdate (mm/dd/yyyy)*

	Current School, if applicable

	Entering Which Grade? *
		- select - 6th 7th 8th Will still be in elementary school

	Interested in admission for the fall of which year?*
		- select - 2009 2010 2011 2012 2013

	How did you first hear of our school?
		Word of Mouth Browsing the Internet Your website Printed advertisement Other:

	Will you be attending the Open House?*
		Yes, we will attend No, we will not attend, but please send admission materials.

Please Note: Questions marked with an asterisk (*) are required.