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Thank you for your interest in Dominion Academy of Dayton! 

Please complete the form below and our Admissions Office will contact you soon. We look forward to speaking with you. 

For immediate questions, please contact the school's main office 937-224-8555. 

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone *
  • How Did You Hear About Us? *
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Current School

  • What type of enrollment are you inquiring about?
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
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