School Application Form
Student Information
Name
First Name
Last Name
Grade
School Last Attended
What is your reasoning for choosing homeschool for your child?
Do you feel like your child is educationally at their grade level? If no, which subject(s) do you feel they are behind in?
Gender
Please Select
Male
Female
N/A
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first
*
Emergency Information
Name
First Name
Last Name
Relationship
Phone Number
Health Information
Please let us know if this child have any allergies
*
Can this child take part in regular physical activities?
Yes
No
Do you want to indicate any related information?
Early Drop Off
Will your child need early drop off each day? Early drop off begins at 630am.
Please Select
Yes
No
Occasionally
Submit
Should be Empty: