Student's Name *

First Name

Last Name

Student's Birthdate *

MM

DD

YYYY

Is there a sibling also applying to Telos Micro School? *

Yes

No

Student Gender *

Female

Male

Non-binary/non-conforming

Transgender

None of these describe my child

Guardian 1 *

First Name

Last Name

Guardian 2 *

(please enter N/A if not applicable)

First Name

Last Name

Guardian 1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 1 Phone *

(###)

###

####

Guardian 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 2 Phone

(###)

###

####

Does child live with both parents? *

Yes

No

How did you hear about Telos Micro School? *

Friend

Acquaintance

Website

Flyer

Social Media

Current student/family

Phone of current school *

(###)

###

####

Date *

MM

DD

YYYY