Child's Name *

First Name

Last Name

Child's Gender *

female

male

Child's Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

Country

(###)

###

####

Parent's Name *

First Name

Last Name

Parent's Cell or Work Phone

(###)

###

####

Sibling on Waitlist?

Yes

Sibling's Birth Date

MM

DD

YYYY

Preferred Start Date *

MM

DD

YYYY

Recommended by

First Name

Last Name

Schedule Preference

Full-time (5 days per week)

Part-time (2 or 3 days per week)

Family is a Member of the Church

Yes

Child has a Sibling at the School

Yes