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Contact our office if you have a question or require assistance in filling out this application.

  • Application for Enrollment

  • (person submitting; first parent / guardian)
  • (or alternate number)
  • Note: This application is viable for one year and must be renewed annually to maintain consideration.
  • Note: Government employment is verified before enrollment. Payment is not needed if you are a state/county employee
  • Additional Information

    For second parent / guardian (if applicable)

    NOTE – Please complete all fields required* below. Thank you.
  • (home number)
  • (or alternate number)
  • Note: Government employment is verified before enrollment
  • How did you become aware of and learn about us?

  • Once this form is complete, click Submit to proceed to payment of the application fee.