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The Perkiomen School - Information Request

Student Information

Given Name​
Family Name
Nickname or "American" Name
(Boarders live on campus; local day students commute from home.)​

Date Seeking Entry:

(Start of School Year)​​
Mid-Year Entry (space limited)​​​​​
Enter Month/Year​​

Please Also Send Me Information on the Following Special Programs:

(Choose All That Apply)

Inquiry Mailing Label

(35 characters maximum)
(35 characters maximum)
(35 characters maximum)
(USA Only​​)

Are You Working With an Educational Consultant or Agency?

Educational Consultant Contact

(Mr./Mrs./Mrs. and full name if known)​​
(35 characters maximum)​
(35 characters maximum)​
(35 characters maximum)​
(USA Only)​​
Please Include Country Code and City Code or Cellular Prefix​
(Please enter one only)

Parent/Guardian Contact

Given Name​​
Family Name​​​
(Please enter one only)

Preferred Phone:

Alternate Phone:

Please Keep Us Informed of Any Changes in Your Parent/Guardian or Educational Consultant E-mail Addresses.

Student Activities

Which of the Following Activities are You Interested in Pursuing at Perk?

(Please choose only those that apply--you are not requried to fill out all 7 lines.)

* All Arts activities are offered during the fall, winter, and spring trimesters with the exception of After-School Theater, which is offered in fall and winter only.

Please Tell Us How You Learned About The Perkiomen School:

(Please select one only)​​​​​​
Name of Station, Publication, or other Media Source
Agency Name
Name or Relationship​​​
Name, Date, or Location of Event
Name of Business/Organization or Representative​

Please List Any Other Friends/Relatives With Perkiomen School Connections:

Inquiry Questions/Comments:

    |     200 Seminary st
    |     pennsburg, pa 18073
    |     215.679.9511
    |     contact us
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