Wait List Form

Date of Application:(Required)

Child’s Date of Birth:(Required)

Child’s Sex:(Required)

Male

Female

Name(Required)

Last First Middle Nickname

Child’s Address:(Required)

Street Address City ZIP

Mother’s Name:(Required)

Father’s Name:(Required)

Mother’s Cell Phone:(Required)

Father’s Cell Phone:(Required)

Mother's Email(Required)

Father's Email(Required)

Does child live with both parents:(Required)

Yes

Are you a member of St. Michael’s Episcopal Church:

Yes

Please email this form to [email protected].

Thank you for your interest in our school. We look forward to meeting you!