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Thank you for your interest in Bitney!

Note: Filling out the simple form below does not ensure enrollment at Bitney Prep, as there is more to the process. However, by taking just a moment to fill out each of the fields below, you can get the ball rolling. You will receive more information after clicking the Submit button.

Student first name *

Student last name *

Current school *

Current grade level *

Student birthdate *

Primary Contact:

Parent first name *	Parent last name *
Parent phone (cell preferred) *	Parent email *
Home address: *

Why does your student want to attend Bitney Prep?

Additional comments:

Required fields are marked with an asterisk(*).