24/25 School Application Form

24/25 School Application Form

Prestige Homeschool Academy
Student Name

First NameLast Name
Which program are you registering for?

2 Day program: Monday/Wednesday 9-22 Day program: Tuesday/Thursday 9-2 (only available for 3-6th graders)4 Day program: Monday-Thursday 9-2 (T/Th option only available for 3-6th graders)
Tshirt Size
Date of Birth

MonthDayYear
Date
Age
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
How many years have you homeschooled?
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Parent/Guardian's Name - Secondary

First NameLast Name
Phone Number
Please enter a valid phone number.
Occupation
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
Health History
Does the student have any allergies? If yes, please list them below:
Does the student currently take any medications? If yes, please list them below:
Does the student have any medical conditions that you would like to declare?
Does the student have any learning challenges?
We absolutely appreciate your interest in our school. However, it's important to note that our current resources and capabilities do not extend to providing specialized services for students who are eligible for special education services. We want to ensure that every child receives the support they need to thrive academically and socially. If this is a concern of yours please contact us with Special Education Services as the subject on your email.
There is a $50 registration fee for Prestige Homeschool Academy. Once your student'(s) application is accepted, you will receive that invoice to secure your spot with PHA. Payment is month to month. If you decide to miss school for an extended amount of time without payment, your student'(s) place in class will become available to a student on the wait list.
Parent/Guardian Signature

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Date Signed

MonthDayYear
Date
Should be Empty:

24/25 School Application Form

Parent/Guardian's Information

Health History