Inquiry/Request Information

Thank you for your interest in Lehrman Community Day School!

Please fill out the form below and our Admissions Office will contact you to provide the information you desire.

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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: Student's current grade level * Student 1 First Name * Middle Name Last Name * Birthdate * (mm/dd/yyyy) Gender * Male Female Grade Level of Interest * School Year * Current School Is There Another Student? Yes No Parent / Guardian Notes