Returning High School Student Application

Returning High School Student Application
Please complete this application to re-enroll for the upcoming academic year. All information will be used to update your student records.
Student Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student ID (if applicable)
Grade Level for Upcoming Year
Current Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Full Name
First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the student have any medical conditions or allergies? If yes, please specify.
List any medications the student is currently taking.
Previous School Year Completed
Should be Empty: