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Thank you for your interest in our school!

Please fill out the form below and our school office will contact you and provide the information you desire.

* If you do not have a home phone, please provide your cell phone number.

If you have any questions, please feel free to call the school office at 815-725-3390.

* Indicates a required field.

Parent/Guardian Information
*First Parent/Guardian
Salutation

First Name *

Last Name *
Email Address *

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

(Ex: 999-999-9999)
Second Parent/Guardian
Salutation

First Name

Last Name
Email Address

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

(Ex: 999-999-9999)
How Did You Hear About Us? *

Details:
Home Phone *

(Ex: 999-999-9999)
Street Address *
City *
Country *
State *
Zip *
Student 1
First Name *

Middle Name

Last Name *
Birthdate *

(mm/dd/yyyy)

Gender *

Male Female
Grade Level of Interest *

School Year *
Current School
Is There Another Student? Yes No
Parent/Guardian Notes

Type in the text that you see above (case sensitive):