New Horizon Application

New Horizon Academy Application Form

2024-2025 School Year
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Child's Gender*
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Grade Level Applying for*
Grade
Child's Current School*
School Name
Child's Current Grade*
Grade
Mother's/Guardian's Name*

First NameLast Name
Mother's/Guardian's Cell Phone Number:*
Mother's/Guardian's E-mail*
example@example.com
Father's/Guardian's Name*

First NameLast Name
Father's/Guardian's Cell Phone Number:*
Father's/Guardian's E-mail*
example@example.com
Does your child have a diagnosis or special needs (ADD, Asperger’s, Dyslexia, etc.)*
Does your child have any medical conditions or allergies of which we need to be aware? *
Are there any security/custody issues with this child?*
If you answered "YES" to either of the questions above, please elaborate.
Security/Custody Issues
Emergency Contact #1*

First NameLast Name
Phone Number*
Emergency Contact #2*

First NameLast Name
Phone Number*
In addition to those listed above (Guardian, Parents, & Emergency Contacts), please list the individuals who are also allowed to pick up your child from school.
.
What are your expectations of New Horizons Academy?*
What are your child's strengths and weaknesses?*
Are there any concerns of which we should be aware? Has your child experienced any difficult challenges? *
Has your child ever had a psychological or educational evaluation? *
Does your child have any health conditions that limit their performance of routine or everyday activities including classwork? Has your child ever received academic or medical accommodations?*
If you answered yes on the questions above, please elaborate. Or if you would like to provide any other additional information, please provide below.
Please upload a most recent report card*

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Please upload a psych report, IEP or any other evaluations/documentation (OT evaluation, SLP evaluation, etc)

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I agree that this information is accurate and true.

My Products*

Registration

$125.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

New Horizon Academy Application Form