Request Information

Dear Guest of our Westlake Christian School Website and Admissions Page:

Thank you for your interest in Westlake.

We appreciate you completing the information below. A member of our Admissions Team will contact you afterward.

Again, many thanks for your interest.

Sincerely,

Jayanne K. Roggenbaum, M.A.T., Psy. Sp.

Head of School

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Parent / Guardian Information
First Parent / Guardian Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)	Second Parent / Guardian (leave blank if not applicable) Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)

Home Address
Street Address City Country State Zip Home Phone (Ex: 999-999-9999) How Did You Hear About Us? Details: We hold tours on Thursdays at 10 a.m. If that day and time do not work for your schedule, please let us know when you might be available. * If yes, when would you like to schedule a tour? Please tell us about any special interest your child has. Student 1 First Name * Middle Name Last Name * Birthdate (mm/dd/yyyy) Email Address Gender Male Female Grade Level of Interest * School Year * Current School Is There Another Student? Yes No Parent / Guardian Notes