In a Perfect World Private School Application Form

In a Perfect World Private School Application Form

Please answer the following questions thoroughly and honestly. In order to ensure the safety and success of all students, we must be aware of any academic or behavioral concerns prior to accepting new students. This information allows us to determine whether we have adequate resources to accommodate and support the child.
Child's Name*

First NameLast Name
Child's Birth Date:*

MonthDayYear
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Child's Grade for 2025-2026 School Year*
Grade
Primary Guardian's Name*

First NameLast Name
Primary Guardian's Cell Phone Number:*
Primary Guardian's E-mail*
example@example.com
Secondary Guardian's Name

First NameLast Name
Secondary Guardian's Cell Phone Number:
Secondary Guardian's E-mail
example@example.com
Has the child attended school before? *
If you answered "YES" to the question above, please elaborate on the type of school (daycare, homeschool, private school, public school) and whether the child's academic performance was below grade level, on grade level, or above grade level.
Academics
Does the child have any medical conditions or special needs? (ADHD, Autism, Dyslexia, etc.)*
If you answered "YES" to the question above, please list the medical diagnoses and/or special needs of the child. What accommodations does your child need in order to be successful in a school setting?
Medical & Special Needs
Does your child have behaviors that may impact the learning or safety of themselves or others?*
If you answered "YES" to the question above, please list the behaviors you are concerned about. What supports does the child need in order to be successful in a school setting?
Behavior
Does your child have any allergies? (peanuts, chocolate, etc.)*
If you answered "YES" to the question above, please list the child's allergies.
Allergies
Name of guardian completing this form*

First NameLast Name
Should be Empty: