Registration Form

1. Student Information

First Name *Last Name *Date of Birth *Gender *— Select Choice —MaleFemale

Student’s First LanguageLanguage(s) Spoken at HomeGrade in School

Parent/Guardian Information

Relationship to Student *Phone *

Email *

Relationship to StudentPhone

Email

Relationship to StudentPhone

3. Health & Safety Information

Allergies (food, medication, other)Medical Conditions or Special NeedsMedications (taken during school hours)

4. School Services & Permissions

Student Pick-Up Permission: Who is authorized to pick up the child?

5. Additional Information

Any behavioral, learning, or emotional support needs?Other notes or requests (optional)

6. Parent Agreement & Signature

Signature *

Clear Signature
Date / Time *

7. Payment Information

Submit