Excelsior Preparatory School admissions

Early Enrollment On Line Application

Please fill out the following information and click Submit:

Early Enrollment

By signing below, I hereby agree and consent with the terms and conditions stated in Excelsior Artz Preparatory School’s Health Form Waiver, Financial Responsibility, Authorization, & Indemnity, PTA Contract, and Academic Agreement for the 2019 - 2020 school year.

I/We am/are selecting tuition plan # *

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Signature of First Parent/Guardian *

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Signature of Second Parent/Guardian

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Today's Date *

Please select today's date

Student Information



Student's Name *

Student's full name is required
Student's Date of Birth (mm/dd/yyyy) *

Please enter students Date Of Birth in the format mm/dd/yyyy
Date of Re-Enrollment


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Grade level entering *












Please select student's gender
Gender *

Please select student's gender
Password *

Last 4 digits of your student's Social Security # is required
Address *

Student's Home Address
City *

Please enter City
State / Region *

State is required
Zipcode *

Zipcode is required

Family Information: Mother



Parent's Name (Mother) *

Mother's name is required
Mother's Email

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Mother's Home Phone Number *

Please enter Mother's phone number
Mother's Cell Phone Number *

Please enter Mother's cell phone number
Mother Phone Carrier

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Is Mother Employed *

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Mother's Work Phone

Please enter Mother's Work Phone
Mother's Work Place *

Please enter mother's workplace
Mother's Occupation *

Please enter Mother's Occupation

Family Information: Father



Parent's Name (Father) *

Father's name is required
Father's Email

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Father's Home Phone Number *

Please enter Father's phone number
Father's Cell Phone Number *

Please enter Father's cell phone number
Father's Phone Carrier

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Is Father Employed *

Is Father Employed?
Father's Work Phone

Please enter Father's Work Phone
Father's Occupation *

Please enter Father's Occupation
Father's Work Place *

Please enter father's workplace

Family Information: Guardian



Guardian's Name

Father's name is required
Guardian's Email

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Guardian's Home Phone Number

Please enter Father's phone number
Guardian's Cell Phone Number

Please enter Father's cell phone number
Guardian's Phone Carrier

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Is Guardian Employed

Is Father Employed?
Guardian's Work Phone

Please enter Father's Work Phone
Guardian's Occupation

Please enter Father's Occupation
Guardian's Work Place

Please enter father's workplace

Student's Medical Information



Primary Physician's Name *

Please enter your Primary Physician's Name
Primary Physician's Phone Number *

Please enter Primary Physician's Telephone Number
May Excelsior Artz Prep. call another physician if unable to contact the one(s) you listed above? *

May Excelsior Artz Prep. call another physician if unable to contact the one(s) you listed above?
List any allergies that your child possesses that you are aware of:

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Other persons to be notified in case of illness or accident

Name/Phone No. *

Please enter the last grade at Student's last school
Name/Phone No,

Please enter parent's name

Safe Release Information




Please list persons, if any, to whom you are permitting Excelsior Artz Preparatory School to release your child without prior verbal consent in the section below:

1. Name / relationship with child / Phone Number:

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2. Name/relationship with child/phone number

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3. Name/relationship with child/phone number

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4. Name/relationship with child/phone number

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If there is a parent who is legally prohibited from picking up the child listed above from school and/or receive school records, please indicate and attach supporting court documents.

Please indicate who:

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