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Student First Name *
Student Middle Name  
Student Last Name *
Gender  
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Student Preferred Name *
Birthdate  
RadDatePicker
RadDatePicker
Open the calendar popup.
mm/dd/yyyy
Proposed Entry Year? *
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Proposed Start  
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Interested in Grade *
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Current School *
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Current Grade Level *
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Street Address *
Parent Name for Envelope Address *
Mr. and Mrs. John Doe
City  
State  
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Zip/Postal Code  
Household Email *
Primary Email Address for Admissions Communications
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Phone 1 Type  
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Parent 1 Phone 1  
Parent 1 Email *
Parent 2 living in same Household with Parent 1-please do not add a secondary parent living in another household, that will be done later.
Parent 2 First Name  
Spouse of Parent 1
Parent 2 Last Name  
Spouse of Parent 1
Parent 2 Phone 1 Type  
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Parent 2 Phone 1  
Parent 2 Email  
How did you hear about The Cottage School?  
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Search Engine, Current Parent, Professional, Other
Who may we thank for referring you?  

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