Student Application Form
Student Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Grade Applying For
*
Call for availability 972-523-2134
Parent(s)/Guardian(s) Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1 Full Name
*
First Name
Last Name
Parent/Guardian 1 Relationship to Student
*
Parent/Guardian 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian 1 Email
*
example@example.com
Parent/Guardian 2 Full Name
First Name
Last Name
Parent/Guardian 2 Relationship to Student
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian 2 Email
example@example.com
Family Information
Marital Status
*
Religious Affiliation/Church
*
How did you hear about Salt and Light Academy?
Student Educational History (if applicable)
Previous School or Daycare
Reason for Transitioning to Salt and Light Academy
Additional Information
Does your child have any allergies, or medical conditions we should be aware of?
*
Yes
No
If yes, please explain
Does your child take daily medication?
*
Yes
No
If yes, please explain
Has your child been diagnosed with any learning disabilities?
*
Yes
No
If yes, please explain
Does your child know their letters?
*
Yes
No
Does your child know their numbers?
*
Yes
No
What are your child’s strengths and interests?
Does the student have any physical limitations that will require an adjustment in the normal activities of the school day? (Including outdoor activities such as gardening, taking care of animals, etc.)
*
Yes
No
If yes, please explain
*Disclaimer: At this time, Salt and Light Academy does not offer specialized academic services, such as speech therapy or occupational therapy, beyond our general education setting. Families should carefully consider their child’s needs when applying, as we are not currently equipped to accommodate certain special services.
Parent Questionnaire
Why do you feel Salt and Light Academy is the best fit for your child?
How can we, as teachers, best support your child’s growth and learning?
Signatures/ Documents
Proof of Childs Age (e.g. birth certificate)
*
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Recent School or Daycare Reports (if any)
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Parent/Guardian 1 Signature
*
Date
*
-
Month
-
Day
Year
Date
Parent/Guardian 2 Signature
Date
-
Month
-
Day
Year
Date
Email
example@example.com
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