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Thank you for your interest in The Winston School!

Please fill out the form below and our Admissions Office will contact you and provide the information you desire.

* Indicates a required field.

Parent/Guardian Information
*First Parent/Guardian
Salutation *

First Name *

Middle Name

Last Name *
Email Address *

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

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

First Name

Middle Name

Last Name
Email Address

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

(Ex: 999-999-9999)
How Did You Hear About The Winston School? *

Details:
Home Phone *

(Ex: 999-999-9999)
Street Address
City
Country
State
Zip

What information would you like The Winston School to provide you? *

	Send information packet		Schedule a tour		Schedule a Meeting with Admissions Director
	Request a telephone call		Request an email

Are you interested in information about Financial Aid? *

Yes No

Would you like to register for an Open House? If so, select a date most convenient for you below.

	Call to schedule a private tour		Thursday, November 9 at 9 a.m.		Sunday, January 28 at 2 p.m.
	Thursday, March 22 at 9 a.m.

Student 1
First Name *

Middle Name

Last Name *
Birthdate

(mm/dd/yyyy)

Email Address

Gender

Male Female
Grade Level of Interest *

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