* Required

Student Information

First Namerequired

Last Namerequired

Streetrequired

Cityrequired

Staterequired

Ziprequired

Genderrequired

Birthdaterequired

Current Schoolrequired

Current Graderequired

School year and grade about which you are inquiring:

Entry Yearrequired

Entry Graderequired

Has your child ever:*

Had a Relative Attend Shelton Been Tutored by a Shelton Teacher Attended Shelton Summer School Attended Shelton Scholars None of the above

Name of Relativerequired

Relationship to Relativerequired

Name of Teacherrequired

Is your child up to date on state-mandated immunizations? *

Yes No

Please Explainrequired

Parent / Guardian #1

Firstrequired

Lastrequired

Relationship to Studentrequired

Marital Statusrequired

Emailrequired

Phonerequired

Parent / Guardian #2

First Name

Last Name

Relationship to Student

Marital Status

Phone

Referred By

Notes