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Peace by Piece Academy New Student Registration
This form is setup for up to 4 children per household please resubmit if you have more than 4 children
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Parent/Guardian LAST Name - if same for all fill out once
Your answer
Parent/Guardian FIRST Name
Your answer
Parent 1 Phone Number
Your answer
Parent 1 Email Address
Your answer
Parent/Guardian 2 LAST Name - if only one guardian leave blank
Your answer
Parent/Guardian 2 FIRST Name
Your answer
Parent 2 Phone Number
Your answer
Parent 2 Email Address
Your answer
Student 1 LAST Name
Your answer
Student 1 FIRST Name
Your answer
Student 1 DOB
MM
/
DD
/
YYYY
Student 1 Grade Level
6
7
8
9
10
11
12
Clear selection
Student 2 LAST Name - if same for all leave blank
Your answer
Student 2 First Name
Your answer
Student 2 DOB
MM
/
DD
/
YYYY
Student 2 Grade Level
6
7
8
9
10
11
12
Clear selection
Student 3 LAST Name
Your answer
Student 3 FIRST Name
Your answer
Student 3 DOB
MM
/
DD
/
YYYY
Student 3 Grade Level
6
7
8
9
10
11
12
Clear selection
Student 4 LAST Name
Your answer
Student 4 FIRST Name
Your answer
Student 4 DOB
MM
/
DD
/
YYYY
Student 4 Grade Level
6
7
8
9
10
11
12
Clear selection
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