Student Micro Home School Registration Form

Micro Home School Student Enrollment

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Student Birth Date

MonthDayYear
Student Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Current Grade of Student
Mother's Name

First NameLast Name
Father's Name

First NameLast Name
Parent Email
example@example.com
Mother's Telephone Number
Format: (000) 000-0000.
Father's Telephone Number
Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Previous School
Do you give permission for your child to be photographed for marketing or social media pages.
Important Information (Please include any IEP's, 504 Plans, allergies, special accommodations) Also include any information that you feel will be necessary for your Childs success while being a student at WizeHouse Academy. Medications that need to be taken during school hours.
Additional Comments.
File Upload (Necessary documents ie: report cards, progress reports, IEP's, 504 Plans, Psychology or Speech reports, Immunization, etc)

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Micro Home School Student Enrollment