Child Enrollment Application Child's Name * First Name Last Name Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Race Ethnicity African American Black Hispanic/Latino Asian White/Caucasian Native American Non Hispanic Other Grade 6 7 8 9 10 11 12 School Parent/Guardian Name First Name Last Name Email * Phone (###) ### #### Annual Household Income $ Thank you!
