Humanities Preparatory Academy

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Student Information

Legal First Name*

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Legal Middle Name

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Legal Last Name*

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Preferred Name

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Grade Entering*

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Date of Birth*

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First language spoken by student*

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Languages spoken at home*

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Address

Street Address*

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City*

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Zip/Postal*

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Home Phone*

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Parent/Guardian 1 Information

First Name*

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Middle Name

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Last Name*

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Email*

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Mobile Phone*

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Work Phone

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Parent/Guardian 2 Information

First Name*

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Middle Name

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Last Name

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Question*

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Mobile Phone*

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Work Phone

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Emergency Contact Information

First Name*

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Middle Name

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Last Name*

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Relationship to Student*

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Email*

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