| Student Information |
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| *First Name: | | *Address 1: | |
| Middle Name: | | Address 2: | |
| *Last Name: | | Country: | |
| Preferred Name: | | City: | |
| *Gender: | | *State/Province: | |
| *Birth Date (mm/dd/yyyy): | | *Postal/Zip: | |
| E-mail: | | *Person Inquiring: | |
| *Home Phone (xxx-xxx-xxxx): | | *Relationship to Student: | |
| Household |
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| *Address 1: | |
| Address 2: | |
| Country: | |
| City: | |
| *State/Province: | |
| *Postal/Zip: | |
| *Phone (xxx-xxx-xxxx): | |
| Resides With: | |
| Parent / Guardian 1 | Parent / Guardian 2 |
| *Prefix: | | Prefix: | |
| *First Name: | | First Name: | |
| Middle Name: | | Middle Name: | |
| *Last Name: | | Last Name: | |
| Suffix: | | Suffix: | |
| *Relationship: | | Relationship: | |
| E-Mail: | | E-Mail: | |
| Mobile Phone (xxx-xxx-xxxx): | | Mobile Phone (xxx-xxx-xxxx): | |
| Business Phone (xxx-xxx-xxxx): | | Business Phone (xxx-xxx-xxxx): | |
| Primary Parent: | | Primary Parent: | |
| Additional Information |
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| *Entering Grade: | |
| *Entering Year: | |
| *Current Grade: | |
| Present School: | |
| If other, please list here: | |
| School City: | |
| School Country: | |
| School State: | |
| Send Financial Aid Information: | |
| *How did you hear about Cape Henry?: | |
| If other, how did you hear about us?: |
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| Questions: |
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