Application: Additional Student | Shalom Extra Miles Education Center

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Programs
Admission & Enrollment
About Us
Contact

Register Another Student

You can use this page to add another child to your registration. Please fill out all required information for the additional student. Once completed, you will return to the confirmation page.

Student's Last Name*

Student's First Name*

Student's Gender*

Male

Female

Student's Age*

Attending Year*

2025-2026 School Year

Summer 2026 Only

2026-2027 School Year

Summer 2027 Only

Future Year

School Name*

School Address*

Student's Age*

Student's Date of Birth*

Student's Grade*

Preschool

Pre-Kindergarten

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

ADA Accommodations Needed (if not applicable, write "N/A")*

Parent/Guardian 1 Name*

Parent/Guardian 1 Phone Number*

Parent/Guardian 2 Name*

Parent/Guardian 2 Phone Number*

Parent Email Address*

Program Selection

Preschool Full-Time (Mon-Friday)

Preschool Part-Time (3 days/week or half-day)

Grades 1-6

Class to Take (Check all that apply)

Reading

Writing

Math

Other

If you selected ‘Other,’ please tell us which class(es).

Health & Medical Information: List any health concerns, medications (dosage & frequency), allergies and medical conditions*

Additional Notes: Please use this space if anything for this student is different from your first registration form (such as address, medical needs, physician, insurance, or pick-up authorizations, etc.). If not applicable, write "N/A".*

Final Acknowledgment By submitting this form, I confirm that all information provided is accurate to the best of my knowledge. I understand and agree to the policies of Shalom Extra Miles, including tuition, attendance, and behavior expectations. I acknowledge that enrollment may be withdrawn if policies are not followed.*

I have read, understood, and agree to the above statement.

Shalom Extra Miles Education Center
5060 S Keystone Ave
Indianapolis, IN 46227

Designed with Love
by RNS Creative Solutions

Phone Number (Text or Call):
(317) 979-8406

This phone number is for general inquiries only. At this time, applications must be completed either online or in person.

Office Hours:
Monday – Friday | 8:00 AM – 8:00 PM