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Home
About
Academics
Enroll
Contact
Calendar

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Enrollment

Application for Enrollment

Name*

Last name*

Email*

Message*

Street Address*

City*

State*

Zip Code*

Student Name*

Sex

Male

Female

Birth Date*

Does your child have an IEP from a public school?*

Yes

No

Relationship to Student*

Father

Mother

Step Father

Step Mother

Other

Parental Status*

Married

Single

Divorced

Widowed

Are you registering using a device with touch screen capabilities?*

Yes

No

LOCATION

2400 Silvan Rd ,

West Terre Haute, IN

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CONTACT

PHONE: (812) 966-1986

EMAIL: Info@Highland-Church.com

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