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Taking the First Step

Thank you for your interest in our school! Complete this information form and our Admission's office will be in touch with you soon. Any questions call us at 276-623-7164. 

  

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • How Did You Hear About Us?
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •