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Register for Student Visit Day or Request Information

Thank you for your interest in Jackson Christian School!

If you are registering for a Student Visit Day, in the Parent/Guardian Notes below, please tell us a about your child(ren). We design student visit days for students in 1st-11th grades.

 

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Gender
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Gender
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone *
    (Ex: 999-999-9999)
  • How Did You Hear About Us?
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Email Address
    Gender
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Academically Driven
    Athletics
    Creative Arts
    Mass Media
    Music
    Journalism
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •