Skip Navigation

Dominion Christian School Banner

Request Information

Thank you for your interest in Dominion Christian School!

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

* Indicates a required field.

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