W.I.S.E. Waitlist Application

W.I.S.E. Academy Waitlist Application

To get on our waitlist, fill out this form correctly and join right away!
Name of parent*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
Children Information
1st Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
YESNOT JUST YET
Does your child have any Special Needs/ Diets/Considerations in order for us to provide necessary resources*
Very Picky EaterHas recently had surgeryTrouble focusingMedical EquipmentDifficulty with self carePlays very rough or aggressiveAlways chews on thingsOverly Sensitive to EnvironmentFood AllergiesOther
If "Other" how can we assist?*
Is your child verbal? Able to have conversation with others and answer to their name?*
Has your child attended another school before? If so, where?
2nd Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Special Needs/ Diets/Considerations*
Very Picky EaterHas recently had surgeryTrouble focusingMedical EquipmentDifficulty with self carePlays very rough or aggressiveAlways chews on thingsOverly Sensitive to EnvironmentFood AllergiesOther
If "Other" how can we assist?
Is your child verbal? Able to have conversation with others and answer to their name?
YESNOT JUST YET
Has your child attended another school before? If so, where?
3rd Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Very Picky EaterHas recently had surgeryTrouble focusingMedical EquipmentDifficulty with self carePlays very rough or aggressiveAlways chews on thingsOverly Sensitive to EnvironmentFood AllergiesOther
If "Other" how can we assist?
YESNOT JUST YET
Special Accommodations/ Diets/Considerations
Has your child attended another school before? If so, where?
Signature*

Powered by Jotform SignClear
Signing Date*

MonthDayYear
Date
Should be Empty:

W.I.S.E. Academy Waitlist Application

Children Information