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Please complete the form below

Student data
Student Name *
Student Name
Name of the child to be enrolled
Student Date of Birth *
Student Date of Birth
The student's birth date (MM/DD/YYYY).
With whom the student resides.
Student primary residence address *
Student primary residence address
Where the student resides.
Does the student require any medication or medical services at school? *
Has anyone in the family previously attended The Garden Schoolhouse (or the Chesterfield Innovative Academy)?
Guardian data
Guardian Name *
Guardian Name
The name of the child's primary guardian.
Guardian address *
Guardian address
Where the student's primary guardian resides.
Guardian phone number *
Guardian phone number
Guardian work phone number
Guardian work phone number
Home details
Additional information