Student

First Name

Last Name

Address

City

State

Zip

Phone

EMail Address

Parent(s) Name

What is your gender identity? (Gender identity means how you feel as a girl, boy, both, or neither)

Gender Other

What is your ethnicity?

Ethnicity Other

T-Shirt Size

Grade

School District

School Name

Scholarship Needed?

Returning Student?

How did you hear about us?

Details

Who referred you to us?

Last name

Special Needs / Comments / Requests

Please note: Requests for placement in classes with other students must be mutual to be considered and are not guaranteed.

Group A Group B Group C

First Choice

Second Choice

Third Choice

Student Registration