Request Information

Thank you for your interest in Canterbury School. After you complete and submit this form, we will send you a packet of information about Canterbury School. If you have other questions, please note them in the questions or comments field.

	Student's First Name*

	Student's Middle Name

	Student's Last Name*

	Gender*

	Name of person making inquiry*

	Relationship to student*

	Street address*

	City*

	State*

	Zip code*

	Country*

	Daytime phone*

	Evening phone

	Email address*

	Name of student's current school

	Student's date of birth (mm/dd/yyyy)*

	Student is applying for what grade?*

	Proposed enrollment month*

	Proposed enrollment school year*

	How did you hear about Canterbury School?

	Additional questions or comments

Please Note: Questions marked with an asterisk (*) are required.

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