Parent Information

Name

Phone (H) (C)

E-mail Adress

Yes, My son/daughter will attend the Parent/teen reception March 7 at 10:30 am (location to be announced)

Student Information

Name

Age Gender Male Female

Phone (C) optional

E-mail Address

Street Address

City State

Zip

Payment Information

Payment Method Check MO Credit/Debit

$75 deposit is due upon registration. This amount will be
applied to full tuition donation. You will be able to pay deposit/tuition using PayPal on the next screen.