Start Your Enrollment Interest Form

Site / Program: — Select a center — Bakersfield Barstow Beaumont Colton Cyberschool Desert Hot Springs Fontana Hesperia Palm Springs Phelan Sports Academy Tehachapi Victorville (7th Street) West Victorville (Palmdale 395) MRA Connect (Virtual)

Have you been previously enrolled with Mojave River Academy? — Select an option — Yes No

Previous school site: — Select a local site — Bakersfield Barstow Beaumont Colton Cyberschool Desert Hot Springs Fontana Hesperia Palm Springs Phelan Sports Academy Tehachapi Victorville (7th Street) West Victorville (Palmdale 395)

Do you have access to a computer? — Select an option — Yes No

Do you have internet access at home? — Select an option — Yes No

Grade level: — Select a grade level — Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Student first name:

Student middle name:

Student last name:

Student suffix:

Student date of birth:

Primary guardian first name:

Primary guardian last name:

Primary guardian phone:

Primary guardian phone ext:

Primary guardian email:

How did you hear about us? Select an option School website Google search Social media Online ad School event Friend or family Referred by someone Other

Secondary guardian first name:

Secondary guardian last name:

Secondary guardian phone:

Secondary guardian phone ext:

Secondary guardian email: