Academy Application to Enroll

Today's Date*
MM slash DD slash YYYY
Student Information
Name*
First Last
Grade in September*
Please enter a number from 8 to 12.
Date of Birth
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Student's Cell Phone
Student's Email
Family / Guardian Information
Father's/Guardian's Name
First Last
Father/Guardian Phone
Father's/Guardian's Address (if different from student)
Street Address Address Line 2 City State ZIP Code
Father's/Guardian's Employment

(name of company)
Work Address
Street Address Address Line 2 City State ZIP Code
Father/Guardian Work Phone
Mother's/Guardian's Name
First Last
Mother/Guardian Phone
Mother's/Guardian's Address (if different from student)
Street Address Address Line 2 City State ZIP Code
Mother's/Guardian's Employment

(name of company)
Mother/Guardian Work Address
Street Address Address Line 2 City State ZIP Code
Mother/Guardian Work Phone

Student Information