Interest list

Tell us a little about your family.

Share only basic information here. When the right pathway opens for your child, we'll follow up. Please do not submit medical, behavioral, legal, or safety details through this form.

Parent/guardian first name

Parent/guardian last name

Phone

Optional

City

State or region

Student age range

We ask for a range — never a full birth date.

Preferred location or virtual

Optional

Desired start period

Optional. e.g. 'Fall 2027' or 'Not sure yet.'

How did you hear about JRX Academy?

Optional

Anything else you'd like us to know?

Optional. Do not include medical, behavioral, legal, safety, or other sensitive student information here.

You may contact me about JRX Academy. I've read the privacy notice.

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