Skip Navigation

Request Information

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