Parent/Guardian Name*

Relationship to Student*

Parent/Guardian Email Address*

Parent/Guardian Phone*

Full Address*

County of Residence*

Student's Name*

Student's Birthday*

Student's Gender*

Student's Current Grade*

Current School or Child Care Center*

Child T-Shirt Size*

How did you hear about Wheeling Country Day School?

Number of Adults Attending Open House

Number of Children Attending Open House

Additional Comments