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Request Information

Thank you for your interest in The Juniper School!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • If you were referred to our school by someone please let us know the name of the family.

  • Gender

  • Please tell us a little about your interest and how we can answer your questions:
    *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Student Interests
  • Current School

  • Gender:
  •  
  • Is There Another Student?
    Yes No
  •