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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.

* Indicates a required field.

Parent / Guardian Information
*First Parent / Guardian
Salutation *

First Name *

Middle Name

Last Name *
Email Address *

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

(Ex: 999-999-9999)
Second Parent / Guardian
Salutation

First Name

Middle Name

Last Name
Email Address

Gender

Male Female
Work Phone

(Ex: 999-999-9999)

Cell Phone

(Ex: 999-999-9999)
How Did You Hear About Us? *

Details:
Home Phone *

(Ex: 999-999-9999)
Street Address *
City *
Country *
State *
Zip *
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