Name & Relationship:

Your Name (Last, First):

Relationship to student:

Student's Name:

Student's Age:

Student's Current Grade:

Contact Information:

E-mail address:

Street Address:

Address (cont'd):

City:

State / Province:

Zip / Postal Code:

Country:

Home Phone Number:

Work Phone Number:

Enrollment Information:

The student would enroll in grade:

Month / Year of Student Enrollment:

Are you interested in summer school?

Additional Information you would like to receive from HMA:

Activities & Athletics Information:

Which athletic team(s) is the student interested in?

Which activity(ies) is the student interested in?

Discovery Method Survey:

How did you first find out about Hargrave?
Select One Alumnus (relative) Alumus (other) Current Cadet Friend Internet Search School Fair Sporting Event School Staff HMA Staff Newspaper Southern Living Boys Life Other Magazine Television A coach Not Listed

How did you find HMA's web site address?
Select One AOL Search Altavista Excite Hotbot In a print ad Infospace Google Lycos Northern Light Peterson's Guide Webcrawler Yahoo Other>>

Other method -please be specific:

If through one of Hargrave's alumni, what is his/her name? Class Year?

Comments or Questions:

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