Schoolhouse

Schoolhouse

For the Excellency of Knowledge Microschool
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level beginning 9/26
School Last Attended
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name - Secondary

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What days will your child be attending The Schoolhouse?
The Schoolhouse holds class from 8:15-3:00 M-F. We do have before and after supervision available from 7:30-8:00am and 3:00-5:00 pm. The fee is $10 a family per day). Will your child need to have before/after school supervision? If so, What days and times?
Type response:
Tell us a about your child, educational experiences to date, and why you believe The Scoolhouse for the Excellency of Knowledge is a good fit for him/her.:
Does the student currently taking any medications? If yes, please list them down below:
Please describe any behavior or self-regulation concerns you have concerning your child. Has your child been removed from a classroom or suspended/expelled from any school setting? Please explain.
Reminders
INTERVIEW. The Schoolhouse will conduct an interview with the student and parent/parents as part of the application process to determine if we will meet the child's needs and family's expectations.

The Schoolhouse maintains a firm commitment to a safe and respectful environment for every child. Bullying, cursing, and disrespectful behavior are not permitted. While we are committed to helping children grow and develop better skills and behaviors, we will not allow any child to create harm or traumatic experiences for others.

We ask that you please be open and transparent when sharing your child’s behavioral history and needs. Addressing concerns together from the beginning allows us to support your child appropriately and protects the well-being of every student in our care.

HOPE Scholarship. The HOPE Scholarship must be applied for prior to June 15th in order to be granted the full scholarship.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
Does the student have any allergies or medical conditions we should be aware of?
Should be Empty:

Schoolhouse

Parent/Guardian's Information

Reminders