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.

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Parent / Guardian Information
First Parent / Guardian Last Name * First Name * Salutation Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)	Second Parent / Guardian (leave blank if not applicable) Last Name * First Name * Salutation Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)

Home Address
Street Address * City * Country * State * Zip * Home Phone * (Ex: 999-999-9999) How Did You Hear About Us? * Details: 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