BCEMS Online Inquiry

First Name of Student: 

Last Name of Student: 

Preferred Name: 

Date of Birth: 

Current School: 

Current Grade: 

Inquiring for Grade: 



For School Year: 



Parent/Guardian Information

Name of Person Completing Inquiry (First and Last Name): 

Relationship to Student:

Cell Phone/Daytime Contact: 


Mailing Address:  

Additional Information

How did you hear about us?

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