Three Stages Student ApplicationToday's Date *Date Care to Begin *Child's DetailsChild's Full Name Nickname *Child's DOB *Phone Number *Address *Student Resides with: *MotherFatherBoth ParentsGuardianYour Relationship with the Child : *MotherFatherGuardianMother's DetailsMother's Name *Mother's Email *Phone Number *Mother's Present Occupation *Address *Father's DetailsFather's Name *Father's Email *Phone Number *Father's Present Occupation *Address *Guardian's DetailsGuardian's Name *Guardian's Email *Phone Number *Guardian's Present Occupation *Address *Other Details -- Child's Physician & Dentist DetailsChild's Physician Name *Child's Physician Phone *Child's Physician Address *Child's Dentist Name *Child's Dentist Phone *Child's Dentist Address *Hospital PreferencesHospital Preference *Phone *Insurer NamePolicy Number0 / 10Person to be called in an emergency , when parent / guardian can't be reached:Name *Phone *Relation to Child *FatherMotherGuardianAddress *Your Child will not be permitted to leave the school without prior authorization from the responsible parent or guardian.It is understood that a two-week notice must be given if your children is withdrawn from School.Parent Signature *Today's Date *Submit ApplicationPlease do not fill in this field.