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Thank you for your interest in our school!

Inquiries for grades K-12, please fill out the information that follows.

Early Learning Center inquiries can be emailed to the director, Jamie Esbenshade, at jamie.esbenshade@lcstaff.net.

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Parent / Guardian Information
*First Parent / Guardian
Salutation *

First Name *

Middle 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

Middle 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
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Zip
Student 1
First Name *

Middle Name

Last Name *
Birthdate

(mm/dd/yyyy)

Email Address

Gender

Male Female
Grade Level of Interest *

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