Information Request Form

Complete the following information request form and we will get back to you soon.

[contactform email=”admissions@landmarkeast.org” subject=”Admissions Information Request Form” success=”You information has been submitted and we will get back to you soon.” akismet=”true”]
[name label=”Your First Name:” required=”true”]
[name label=”Your Last Name:” required=”true”]
[textfield label=”Relationship to Student:” required=”true”]
[textarea label=”Mailing Address:”]
[textfield label=”Phone:” required=”true”]
[email label=”Email:” required=”true”]

[textfield label=”Student’s Name:” required=”true”]
[textfield label=”Student’s Birth Date:”]
[textfield label=”Student’s Age:”]
[textfield label=”Current Grade:”]
[textfield label=”School Attending:”]

[checkbox label=”I can be contacted by email”]
[checkbox label=”I can be contacted by phone”]
[textfield label=”How did you hear about Landmark East School?”]
[textarea label=”Comments:”]
[/contactform]

6 Replies to “Information Request Form”

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