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Thank you for your interest in Bethany Academy!

I would love to talk with you.  Complete the form below and I will contact you.

 

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Parent / Guardian Information
  • First Parent / Guardian
  • Last Name *
  • First Name *
  • Middle Name
  • Salutation
  • Email Address *
  • Gender
    Male    Female
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent / Guardian
    (leave blank if not applicable)
  • Last Name *
  • First Name *
  • Middle Name
  • Salutation
  • Email Address *
  • Gender
    Male    Female
  • 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:
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  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Email Address
    Gender *
    Male    Female
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Music
    Sports
  • Current School
  •  
  • Is There Another Student?
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  • Parent / Guardian Notes
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