Welcome
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About the Student
Name
First
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Gender
Date of Birth
mm/dd/yyyy
Is this student an international student?
Yes
No
Current Grade
Not yet in school
PS
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Interested in Grade
PS
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
For the Fall of
2023-2024
2024-2025
Current School
Powhatan School
St. James' Episcopal School
St. John the Evangelist Catholic School
Epiphany Catholic School
Grymes Memorial School
Child Care and Learning Center
Rappahannock County Public School
Warren County Public School
Culpeper County Public School
Fauquier Country Public School
Page County Public School
Other
Current School
About the Parent/Guardian
Name
Mr.
Mrs.
Ms.
Dr.
Title
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Student
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Guardian
Primary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from Wakefield Country Day School. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to 1-888-291-6146.
Yes
No
Secondary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from Wakefield Country Day School. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to 1-888-291-6146.
Yes
No
Email
Mailing Address
Broadening Horizons
Academic Interests:
Art
Band/Music
Computers/Technology
Foreign Languages
National Honor Society
School Yearbook
Speech & Debate
Academic Team
Science Fair
Student Council
Drama
Other
Please Specify:
Athletic Interest:
Lacrosse
Basketball
Skiing
Cross Country
Soccer
Equestrian
Volleyball
Equestrian
Other
Please Specify:
Siblings
Number of Potential Students
0
1
2
3
4
Sibling 1
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Applicant
Sister
Brother
Stepsister
Stepbrother
Half Sister
Half Brother
Date of Birth
mm/dd/yyyy
Grade
Not yet in school
Pre-K/Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Out of school
Current School
Sibling 2
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Applicant
Sister
Brother
Stepsister
Stepbrother
Half Sister
Half Brother
Date of Birth
mm/dd/yyyy
Grade
Not yet in school
Pre-K/Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Out of school
Current School
Sibling 3
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Applicant
Sister
Brother
Stepsister
Stepbrother
Half Sister
Half Brother
Date of Birth
mm/dd/yyyy
Grade
Not yet in school
Pre-K/Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Out of school
Current School
Sibling 4
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Applicant
Sister
Brother
Stepsister
Stepbrother
Half Sister
Half Brother
Date of Birth
mm/dd/yyyy
Grade
Not yet in school
Pre-K/Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Out of school
Current School
Thanks for reaching out! Out of curiosity...
How did you hear about Wakefield Country Day School?
Friend
Website
School Visit
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Referral
Other
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