Parent Information

Primary Parent's First Name *

Primary Parent's Last Name *

Home Address *

City *

State *

Postal code *

Cell Phone # *

Work Phone #

Email *

As a feature to promote an optimal learning climate for SAGE Civic Institute students, at least one parent is required to enroll in our parenting workshop, Raising Highly Capable Children (RHCC). The cost of the workshop is included in the cost of tuition. Additional details will be provided during an open house orientation in September. Do you agree to participate in RHCC as part of your family's enrollment commitment? *

Yes

Second Parent Information

Second Parent's First Name *

Second Parent's Last Name *

Second Parent's Home Address

Second Parent's City

Second Parent's State

Second Parent's Postal Code

Second Parent's Cell Phone #

Second Parent's Work Phone #

Second Parent's Email Address

Student Information

Student First Name *

Student Last Name *

Student Email Address *

Student Birthday *

Student Age as of September 2023 *

Student Grade *

Student date of most recent health physical *

Student have any known allergies? *

Student have any medical conditions we should be aware of? *

SAGE families are responsible for sending students with lunch and snacks. Lunch may be provided, for an additional cost by Orchid Cafe which is located inside the The Lab at ConnCorp. Are you interested in signing up for our prepared lunch program? *

Yes

Not Sure

Sibling Information

Sibling First Name

Sibling Last Name

Sibling Email Address

Sibling Birthday

Sibling age as of September 2023

Sibling Grade

Sibling date of most recent health physical

Sibling have any known allergies?

Sibling have any medical conditions we should be aware of?

Second Sibling Information

Second Sibling First Name

Second Sibling Last Name

Second Sibling Email Address

Second Sibling Birthday

Second Sibling age as of September 2023

Second Sibling Grade

Second Sibling Date of most recent health physical

Second Sibling any known allergies?

Second Sibling any medical conditions we should be aware of?

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