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Request Information

Thank you for your interest in Bethany Lutheran School!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Sex *
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Sex *
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • How Did You Hear About Us?
    Details:

  • Marital Status
    *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Sex *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Is the student a US citizen?
    * Yes   No

  • Are there any social/academic concerns?
    * Yes   No
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •