Pre-enrollment form

[select_posttype enrollment-campus id:enrollment-campus include_blank class:form-control "campus"]

Students

[text enrollment-kid1-name id:enrollment-kid1-name class:form-control placeholder "Student's LEGAL First, Middle, Last Name"]
[text enrollment-kid1-gender id:enrollment-kid1-gender class:form-control placeholder "Gender"]
[text enrollment-kid1-dob id:enrollment-kid1-dob class:form-control placeholder "Date of Birth"]
[text enrollment-kid1-grade id:enrollment-kid1-grade class:form-control placeholder "Grade for Current Year"]

[radio enrollment-kid1-ethnicity id:enrollment-kid1-ethnicity use_label_element "Caucasian/White" "Hispanic" "Black" "American Indian" "Alaska Native" "Pacific Island/Asia" ]

[text enrollment-kid1-district id:enrollment-kid1-district class:form-control placeholder "Last School District"]
[text enrollment-kid1-attended id:enrollment-kid1-attended class:form-control placeholder "Last School Attended"]
[text enrollment-kid1-spec-edu id:enrollment-kid1-spec-edu class:form-control placeholder "Any Special Education Consideration?"]

[text enrollment-kid2-name id:enrollment-kid2-name class:form-control placeholder "Student's LEGAL First, Middle, Last Name"]
[text enrollment-kid2-gender id:enrollment-kid2-gender class:form-control placeholder "Gender"]
[text enrollment-kid2-dob id:enrollment-kid2-dob class:form-control placeholder "Date of Birth"]
[text enrollment-kid2-grade id:enrollment-kid2-grade class:form-control placeholder "Grade for Current Year"]

[radio enrollment-kid2-ethnicity id:enrollment-kid2-ethnicity use_label_element "Caucasian/White" "Hispanic" "Black" "American Indian" "Alaska Native" "Pacific Island/Asia" ]

[text enrollment-kid2-district id:enrollment-kid2-district class:form-control placeholder "Last School District"]
[text enrollment-kid2-attended id:enrollment-kid2-attended class:form-control placeholder "Last School Attended"]
[text enrollment-kid2-spec-edu id:enrollment-kid2-spec-edu class:form-control placeholder "Any Special Education Consideration?"]

[text enrollment-kid3-name id:enrollment-kid3-name class:form-control placeholder "Student's LEGAL First, Middle, Last Name"]
[text enrollment-kid3-gender id:enrollment-kid3-gender class:form-control placeholder "Gender"]
[text enrollment-kid3-dob id:enrollment-kid3-dob class:form-control placeholder "Date of Birth"]
[text enrollment-kid3-grade id:enrollment-kid3-grade class:form-control placeholder "Grade for Current Year"]

[radio enrollment-kid3-ethnicity id:enrollment-kid3-ethnicity use_label_element "Caucasian/White" "Hispanic" "Black" "American Indian" "Alaska Native" "Pacific Island/Asia" ]

[text enrollment-kid3-district id:enrollment-kid3-district class:form-control placeholder "Last School District"]
[text enrollment-kid3-attended id:enrollment-kid3-attended class:form-control placeholder "Last School Attended"]
[text enrollment-kid3-spec-edu id:enrollment-kid3-spec-edu class:form-control placeholder "Any Special Education Consideration?"]

Other Information




[checkbox enrollment-hearabout id:enrollment-hearabout use_label_element "Mail" "Website" "Facebook" "Referral" "Other" ]



[text enrollment-referrel id:enrollment-referrel class:form-control placeholder "Referral or Other Info"]
[text enrollment-parent id:enrollment-parent class:form-control placeholder "Parent/Guardian"]
[text enrollment-phone-home id:enrollment-phone-home class:form-control placeholder "Home Phone"]
[text enrollment-phone-cell id:enrollment-phone-cell class:form-control placeholder "Cell Phone"]
[text enrollment-address id:enrollment-address class:form-control placeholder "Street Address"]
[text enrollment-city id:enrollment-city class:form-control placeholder "City, State, Zip"]
[text enrollment-email id:enrollment-email class:form-control placeholder "Email"]
[text enrollment-already-attending id:enrollment-already-attending class:form-control placeholder "List any siblings already attending"]

Noah Webster School does not discriminate on the basis of race, color, national, origin, sex, age or disability in employment, treatment, admission or access to educational programs and activities. Inquiries concerning perceived discrimination may be referred to the School’s HR Director, Jen Pennington, located at 7301 E. Baseline Rd, Bldg 100, Room 103, Mesa, AZ 85209, or your immediate supervisor if you are an employee You may also contact the HR Director by phone at 480-986-2335 x 2103.