High School dates Please select the date when you would like to attend an upcoming Informational Visit. Wednesday, October 27 (in person) Wednesday, December 8 (virtual) Wednesday, December 15 (in person) Wednesday, January 19 (in person) Saturday, January 22 (in person) Wednesday, February 9 (in person) Wednesday, February 23 (virtual) Student Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Student's preferred pronoun * Student's preferred email address * Street Address * Street Address 2 City/Town * State * NoneAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Countries - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Current School * Current Grade * - Select -123456789101112 Day or Residential? * Day Residential (grades 9 – 12) Undecided Desired Program and Year of Entry * Summer 2022 Fall 2022 Summer and Fall 2022 Other Extracurriculars Please list 1-2 hobbies, interests, or other activities of the student. Number of attendees * In order to accommodate as many families as possible for in-person visits, we are limiting the number of visitors to two per family, either a student and parent/guardian or two parents/guardians. 1 2 Will the student be attending the visit? * YesNo Will the student be attending the visit? * Will the student be attending the visit? - Yes Will the student be attending the visit? - No Parent(s)/Guardian(s) Attending * Parent/Guardian preferred email address * Preferred phone number * Attestation * The following attestation must be completed regardless of your vaccination status. I attest that any person within our group WILL NOT come to the Landmark School campus if any of the following symptoms are present: Temperature greater than 100°F Chills (with other symptoms) Diarrhea Nausea Vomiting Sore throat Cough (new onset) Shortness of breath or difficulty breathing Congestion Runny nose with other symptoms (not due to a known cause) New loss of taste or smell Headache (with other symptoms) Muscle or body aches (with other symptoms) Fatigue (with other symptoms). I attest that any person within our group WILL NOT come to the Landmark School campus if anyone in the household has been exposed to a positive case of COVID-19 in the past 14 days. I attest that if any person within our group has any of the COVID symptoms outlined above within 48 hours after visiting Landmark School, we will contact the Landmark Health Center. High School Health Center: (978) 236-3264 or hshealthcenter@landmarkschool.org I agree Leave this field blank
