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Request Information

Thank you for your interest in Ebenezer Christian School!

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

Also note that if you are inquiring about enrollment for your young child into preschool for a year other than this school year or the next, there is a place for you to indicate the anticipated year of entry for your child.  Your child needs to be 4 years old by September 1 of the year they would enter preschool.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First 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:

  • What church are you currently attending, and how long have you attended this church?
    *

  • Year of entrance, if other than this year or the coming school year:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •