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Thank you for your interest in Dominion Christian Schools!

Please complete the information below and our Admissions Office will contact you directly within 48 hours.

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Parent / Guardian Information
*First Parent / Guardian
Salutation *

First Name *

Middle Name

Last Name *
Email Address *

Gender

Male Female
Cell Phone

(Ex: 999-999-9999)
Second Parent / Guardian
Salutation

First Name

Middle Name

Last Name
Email Address

Gender

Male Female
Cell Phone

(Ex: 999-999-9999)
How Did You Hear About Us? *

Details:
Home Phone *

(Ex: 999-999-9999)
Street Address
City
Country
State
Zip
Student 1
First Name *

Middle Name

Last Name *
Birthdate

(mm/dd/yyyy)

Email Address

Gender

Male Female
Grade Level of Interest *

School Year *
Student Interests
Current School
Is There Another Student? Yes No
Parent / Guardian Notes