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Family Information Form

Thank you for your interest in Gateway Academy! 

Please fill out the form below and our Admissions Office will reach out to you soon.


* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender *
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone *
  • How Did You Hear About Us? *
    Details:

  • Is this inquiry for our private 3k or 4k class?
    * Yes   No
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Student's Age:
    *

  • Does the student have an IEP?
    * Yes   No

  • Student Interests
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •