Child's Name

First Name

Last Name

Child's Date of Birth

YYYY

Gender

Year of Enrollment

(Children must be 2.9 by the start of the school year.)

Name of Parent 1

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name of Parent 2

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Of which town are you a resident?

(Priority is given to residents of the Up-Island Regional School District. Enrollment is first offered to families residing in Chilmark or Aquinnah, then West Tisbury and then the down island towns.)

Chilmark

Aquinnah

West Tisbury

Vineyard Haven

Oak Bluffs

Edgartown

Do you have a child enrolled at the Chilmark School?

(Priority is given to families currently enrolled in the Chilmark School.)

Do you intend to send your child to the Chilmark School?

(Priority is given to families intending to enroll in the Chilmark School.)

Preferred Schedule

(Please select one. School day is 8:00-3:00 pm. Priority is given to families choosing the 5 day option.)

5 Days

4 Days

3 Days