Enrollment Information

Student Information

Please complete the form below. Required fields marked with an asterisk *

Student Last Name*

Answer required for "Student Last Name"

Student First Name*

Answer required for "Student First Name"

Student Middle Name*

Answer required for "Student Middle Name"

Student Nickname/Preferred Name

Answer required for "Student Nickname/Preferred Name"

Hispanic/Latino*

Answer required for "Hispanic/Latino"

Yes

Ethnicity*

Answer required for "Ethnicity"

Student Address*

Answer required for "Student Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

If not in Indiana, please the location

Answer required for "If not in Indiana, please the location"

Student lives with*

Answer required for "Student lives with"

Birth Place (City, State, Country)*

Answer required for "Birth Place (City, State, Country)"

Date first attended a U.S. school*

Answer required for "Date first attended a U.S. school"

List ANY medical conditions, allergies and/or medications for this student (if none, please type none)*

Answer required for "List ANY medical conditions, allergies and/or medications for this student (if none, please type none)"

Does student have any food allergies?*

Answer required for "Does student have any food allergies?"

Yes

If yes, please list food allergies and describe consequences in detail

Answer required for "If yes, please list food allergies and describe consequences in detail"

Please Note: Parent email addresses will be used to communicate with parents via KIT and Daily Announcements.

Parent/Guardian 1 Information

Parent/Guardian 1 Name*

Answer required for "Parent/Guardian 1 Name"

Relationship to Student*

Answer required for "Relationship to Student"

Preferred language for communications*

Answer required for "Preferred language for communications"

English

Spanish

Emergency Contact*

Answer required for "Emergency Contact"

Yes

Parent/Guardian 1 Address*

Answer required for "Parent/Guardian 1 Address"

City*

Answer required for "City"

If not in Indiana, please the location

Answer required for "If not in Indiana, please the location"

Zip/Postal*

Answer required for "Zip/Postal"

Parent/Guardian 1 Cell Phone*

Number Required

Parent/Guardian 1 Email*

Answer required for "Parent/Guardian 1 Email"

Parent/Guardian 1 Employer*

Answer required for "Parent/Guardian 1 Employer"

Parent/Guardian 1 Work Phone*

Number Required

Parent/Guardian 2 Information

Parent/Guardian 2 Name

Answer required for "Parent/Guardian 2 Name"

Relationship to Student

Answer required for "Relationship to Student"

Preferred language for communications

Answer required for "Preferred language for communications"

English

Spanish

Emergency Contact

Answer required for "Emergency Contact"

Yes

Parent/Guardian 2 Address

Answer required for "Parent/Guardian 2 Address"

City

Answer required for "City"

If not in Indiana, please the location

Answer required for "If not in Indiana, please the location"

Zip/Postal

Answer required for "Zip/Postal"

Parent/Guardian 2 Email

Answer required for "Parent/Guardian 2 Email"

Parent/Guardian 2 Cell Phone

Number Required

Parent/Guardian 2 Employer

Answer required for "Parent/Guardian 2 Employer"

Parent/Guardian 2 Work Phone

Number Required

Parent/Guardian 3 Information

Parent/Guardian 3 Name

Answer required for "Parent/Guardian 3 Name"

Relationship to Student

Answer required for "Relationship to Student"

Preferred language for communications

Answer required for "Preferred language for communications"

English

Spanish

Emergency Contact

Answer required for "Emergency Contact "

Yes

Parent/Guardian 3 Address

Answer required for "Parent/Guardian 3 Address"

City

Answer required for "City"

If not in Indiana, please the location

Answer required for "If not in Indiana, please the location"

Zip/Postal

Answer required for "Zip/Postal"

Parent/Guardian 3 Cell Phone

Number Required

Parent/Guardian 3 Email

Answer required for "Parent/Guardian 3 Email"

Parent/Guardian 3 Employer

Answer required for "Parent/Guardian 3 Employer"

Parent/Guardian 3 Work Phone

Number Required

Emergency Contact Information

Emergency Contact, other than parent*

Answer required for "Emergency Contact, other than parent"

Relationship to student*

Answer required for "Relationship to student"

Phone Number*

Number Required

Emergency Contact, other than parent

Answer required for "Emergency Contact, other than parent"

Relationship to student

Answer required for "Relationship to student"

Phone Number

Number Required

Please fix the highlighted areas below before submitting.

Enrollment Information