Application Form

Student Photo *

Name *

Address *

manageMemberFields.fields.AddressLine

common.city

common.area

manageMemberFields.fields.ZipCode

Mobile Phone *

Email *

Birthdate *

COPPA *

I agree to comply with COPPA and am over 13 years of age.

Immunization *

I wish to opt out of immunization requirements

I will provide immunization Records

File

Grade Selection *

Application fee and Registration agreement *

Non-refundable fee of $500 (Check box to continue to payment)

Note - "Registration is not complete until payment has been submitted"

Fee Agreement. *

By checking this box, you agree to Application and Tution fee requirements.

Signature Required for application *common.clear

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