Anniston Academy Enrollment Application
Please complete a separate application for each child. This application is comprehensive. Please ensure you have adequate time to complete it and upload all required documents, including: birth certificate; immunization record; insurance card(s); IEP or support plans (if applicable); and homeschool records (if applicable). Thank you for your time and attention to detail—we look forward to learning more about your child!
Student Information
Student Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Sex
*
Please Select
Male
Female
Race and/or Ethnicity
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parent or Guardian #1 Information
Parent or Guardian #1 Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Employment Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone
*
Please enter a valid phone number.
Relationship to Student
*
Please Select
mother
father
grandmother
grandfather
aunt
uncle
other
If you selected "other," please explain.
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Parent or Guardian #2 Information
Parent or Guardian #2 Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Employment Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone
*
Please enter a valid phone number.
Relationship to Student
*
Please Select
mother
father
grandmother
grandfather
aunt
uncle
other
If you selected "other," please explain.
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Emergency Contact #1 Information
Emergency Contact #1
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Relationship to Student
*
Please Select
mother
father
grandmother
grandfather
aunt
uncle
friend
other
If you selected "other," please explain.
Is this person permitted to check your child out of school?
*
Yes
No
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Emergency Contact #2 Information
Emergency Contact #2
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Relationship to Student
*
Please Select
mother
father
grandmother
grandfather
aunt
uncle
friend
other
If you selected "other," please explain.
Is this person permitted to check your child out of school?
*
Yes
No
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Emergency Contact #3 Information
Emergency Contact #3
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Relationship to Student
*
Please Select
mother
father
grandmother
grandfather
aunt
uncle
friend
other
If you selected "other," please explain.
Is this person permitted to check your child out of school?
*
Yes
No
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Authorized & Unauthorized Student Pickup
Is there anyone NOT permitted to sign your student out? If so, please enter this information below.
*
If the above is related to litigation, please provide any documentation so that we can add it to your student's records.
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Authorization for Educational Records Request
Student Name
*
First Name
Middle Name
Last Name
Social Security Number
*
Name of Most Recent School Attended
*
School Phone Number
*
Please enter a valid phone number.
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year(s) Student Attended
*
Highest Grade Level Student Has Completed
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daycare / not old enough
PreK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
I authorize the release of my child’s educational records to Anniston Academy.
*
Yes
No
Signature
*
Relationship to Student
*
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Primary Care/Pediatrician Information
Student's Primary Care Provider
*
First Name
Last Name
Primary Care Provider Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Care Provider Phone Number
*
Please enter a valid phone number.
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About Your Child
Uniform Shirt Size
*
Please Select
2T
3T
4T
5T
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Adult 3x
While our classrooms are multi-age in structure, we are required to designate a specific grade level for each student for academic records and assessment purposes. Families may choose to have their child repeat a grade without prior approval; however, advancing a student beyond their age-based grade level requires prior permission from school administration. Please indicate the grade level in which you are enrolling your child for the upcoming academic year.
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PreK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Is your child repeating a grade level this year?
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Yes
No
What led you to explore Anniston Academy for your child? Why do you want your child to attend Anniston Academy?
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Are there specific goals or priorities you have for your child this school year?
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What are your family’s top 3 priorities for your child’s education? How does your family support learning and growth at home?
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Please share a bit about your student's previous school experiences and current attitudes towards school.
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How does your child respond to outdoor learning, sensory exploration, or hands-on experiences? How does your child typically interact with peers in small group or mixed-age settings?
*
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Behavior and Home Life
How would you describe your child’s personality? What are your child’s interests or favorite activities? Are there any talents, hobbies, or passions you’d like us to know about?
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What motivates your child?
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What are your child’s greatest strengths? What are your child’s current challenges—academically, socially, or behaviorally?
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What strategies help your child calm down or self-regulate when upset? Are there any triggers we should be aware of? Are there any strategies you use at home that work well when your child is frustrated or dysregulated?
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Are there any family circumstances we should be aware of to best support your child?
*
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School Activities and Family Involvement
Will your child attend before or after school care? (This is a cost in addition to tuition.)
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Yes
No
If yes, please indicate the days your student will be utilizing before or after school care.
Monday
Tuesday
Wednesday
Thursday
Friday
If yes, please indicate the times your student will be utilizing before or after school care.
6:00-7:00 AM
7:00-7:45 AM
3:15-4:00 PM
4:00-5:00 PM
5:00-6:00 PM
Will your child attend our childcare programs during school breaks? (This is a cost in addition to tuition.)
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Yes
No
If yes, please indicate the school breaks you will be utilizing our childcare program.
Fall Break
Winter Break
Spring Break
Summer Break
Would you like to join the Family Council? Once established, the Family Council will assist with fundraisers, school events, volunteer work, special projects, maintaining the school garden, etc.
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Yes
No
If yes, do you have any skills, interests, or resources you’d like to share with our school community?
Are you interested in participating in a school-wide book club?
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Yes
No
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Student Support Needs
To help us better support your child, please select any current diagnoses (check all that apply):
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Autism Spectrum Disorder (ASD)
Attention-deficit/hyperactivity disorder (ADHD)
Developmental Delay
Giftedness
Speech/Language Delays
Learning Disabilities (e.g., Dyslexia, Dyscalculia)
Visual or Hearing Impairments
Epilepsy or Seizure Disorders
Sensory Processing Disorder
Anxiety or Mood or Conduct Disorders
Cerebral Palsy
Down Syndrome
Gross/Fine Motor Delay
There is a formal diagnosis, but it is not listed here.
No formal diagnosis at this time, but testing is in progress or being pursued.
No formal diagnosis at this time and testing is not being pursued.
If your student's diagnosis is not listed above, please share it here.
What therapeutic services does your student CURRENTLY receive?
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speech
feeding therapy
occupational therapy
ABA
behavioral therapy
physical therapy
music therapy
My child receives services that are not listed above.
My child does not receive services.
If a service your student receives is not listed above, please share it here.
If your student receives ABA, please enter the number of hours per week your student receives.
What therapeutic services would you like your student to receive in the future?
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speech therapy
feeding therapy
occupational therapy
ABA
behavioral therapy
physical therapy
music therapy
I would like my child to receive a service that is not listed above.
I don't want my child to receive services.
My child does not need services.
If a service you would like your student receive is not listed above, please share it here.
How would YOU classify your student's level of required support in a classroom setting?
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Low - Needs occasional age-appropriate redirection or reassurance. Able to participate in age-appropriate group settings with minimal adult intervention.
Moderate - Benefits from some small-group or 1:1 support.
High - My child requires frequent 1:1 support or close adult supervision most of the time.
Does your child use any assistive technology at school or home (e.g., AAC device, tablet, specialized headphones)?
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Yes
No
Has your child ever experienced any disciplinary problems at a previous school?
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Yes
No
Does your child take medication for a learning or behavioral issue?
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Yes
No
Does your child require emergency medication (e.g., EpiPen, inhaler, etc.)?
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Yes
No
Does your child have any allergies?
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Yes
No
Will your student be accompanied by private support personnel (such as a CNA or other professionally trained aide)? If so, that individual will be required to complete a background check with us before providing services on campus.
*
Yes
No
If you answered yes to any item above, please explain.
Are you willing to obtain additional support for your child should we recommend additional services?
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Yes
No
Is there anything else you’d like us to know to best support your child and your family?
*
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Tuition & Financial Aid
How do you plan to pay your student's tuition?
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state-funded programs, education savings accounts, or scholarships
payment plan (monthly, quarterly)
one-time full payment for the academic year
Please select all that you have applied for:
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Education Freedom Scholarship (EFS) (school voucher program)
Individualized Education Account (IEA) Program
Katie Beckett Waiver
None
Other
If you selected "other," please explain.
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File Upload
Birth Certificate
*
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Immunization Record (Please also have your doctor's office fax your student's immunization record to 931-919-1169.)
*
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IEP, 504, or Other Academic/Behavioral Plans (if applicable)
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Court Orders, Parenting Plans, and/or Guardianship Papers (for any students not living with both legal parents)
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Front and Back of Insurance Card (if applicable) (Please note: If this information is not provided, we will be unable to bill your insurance. You will be responsible for the full cost of any therapeutic services rendered.)
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Homeschool Records (if applicable)
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1. Mission & Inclusion Acknowledgment
Anniston Academy is an inclusive, evidence-based therapeutic school that embraces diversity, encourages critical thinking, and promotes respect for all identities and perspectives. Our curriculum may include topics such as evolution, climate science, world religions, and social equity. These are explored in age-appropriate, thoughtful ways that reflect our commitment to preparing students for a diverse and interconnected world. As a private institution, we do not offer opt-outs related to content involving diversity, inclusion, or science. Respecting and affirming others’ backgrounds and lived experiences is a non-negotiable part of our school culture.
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2. Student and Family Handbook Acknowledgement
Please take some time to review the Student and Family Handbook. A copy will be emailed to you once your enrollment is complete.
I understand that this handbook outlines the school’s policies, procedures, values, and expectations for students, families, and staff. I agree to support these expectations in partnership with the school and to help foster a respectful, inclusive, and developmentally appropriate environment. I recognize that the policies described in this handbook are designed to ensure the safety, dignity, and growth of all students—academically, socially, and emotionally. I also understand that Anniston Academy is committed to evidence-based educational practices and inclusive classroom experiences that may include diverse perspectives, scientific topics, and social responsibility. I agree to reinforce these expectations with my student(s), to communicate openly with the school when concerns arise, and to contribute positively to the Anniston Academy community throughout the school year. I understand that failure to uphold this agreement may result in consequences, including potential dismissal from the school community.
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I acknowledge receipt and review of the Anniston Academy Parent Handbook, including policies related to student behavior and discipline. I understand and agree to the following: Anniston Academy uses a therapeutic, individualized approach to behavior. My child may be subject to behavioral assessments, interventions, or redirection. Staff may remove my child from group settings if safety is a concern, and I may be required to attend behavior meetings or provide outside evaluations. Repeated safety concerns or inability to implement a supportive plan may result in modified attendance, temporary suspension, or disenrollment.
3. Confidentiality & Proprietary Information Agreement
I affirm that I will not share, distribute, or disclose any proprietary information outside of the school community. This includes, but is not limited to, internal policies and procedures, employee and student handbooks, curriculum materials, internal communications, and operational documents. I understand that this information is intended solely for use within the Anniston Academy community and that protecting the confidentiality of school-related materials is essential to maintaining the integrity and security of our educational environment.
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I acknowledge and agree to follow the Confidentiality & Proprietary Information Agreement as outlined above.
4. Mutual Respect & Public Conduct Policy
I understand that while questions or concerns may arise, I will not engage in public or private disparagement of the school, its staff, or its students—whether in person, in writing, or via social media. I agree to address any issues through appropriate channels such as direct communication with school leadership, in accordance with Anniston Academy’s commitment to transparency, collaboration, and problem-solving. I understand that maintaining a culture of mutual respect and professionalism is essential to the wellbeing of the entire school community. I understand that failure to uphold this agreement may result in consequences, including potential dismissal from the school community.
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I acknowledge and agree to communicate concerns or conflicts with Anniston Academy directly, respectfully, and in good faith.
5. Nature-Based Play & Outdoor Learning Acknowledgment
I understand that my child will engage in activities that may involve water, mud, soil, sand, plants, and other natural materials, and that clothing, shoes, and personal items may become dirty or worn as a result.I support the school’s philosophy that unstructured outdoor play promotes creativity, sensory development, emotional regulation, and a deeper connection to the natural world. I agree to dress my child appropriately for outdoor learning and understand that messes are not only expected—but celebrated—as a meaningful part of their growth and development.
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I acknowledge that Anniston Academy embraces nature-based play, outdoor exploration, and hands-on learning as essential components of the school experience.
6. Photo & Media Release Agreement
Anniston Academy may photograph or video students during school-related activities for use in school publications, newsletters, the website, and social media. These images may also be used for promotional or educational purposes to highlight student learning and community events.
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I give permission for my child to be photographed or included in any school-related media.
I do not give permission for my child to be photographed or included in any school-related media.
7. Financial Policy
By enrolling at Anniston Academy, parents and guardians agree to pay all tuition and school-related fees in a timely manner, according to the payment schedule outlined in the enrollment agreement or as otherwise communicated by school administration. Failure to make payments on time may result in late fees, suspension of services, or, in serious cases, dismissal from the school. If financial hardship arises, families are encouraged to communicate proactively with administration to explore possible solutions or accommodations. We appreciate your partnership in maintaining the financial stability necessary to provide high-quality, consistent educational services. Tuition covers educational expenses only; therapy services (speech, OT, ABA, etc.) are billed separately and expected to be covered by health insurance. Families without active insurance will be billed directly at the school’s cash rate.
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I understand that I am responsible for timely tuition payments according to the school’s published tuition schedule, regardless of my child’s attendance or participation unless otherwise stated in writing by administration. If tuition is not paid by the due date and no payment arrangement has been made, I acknowledge that my child may be temporarily suspended from attending school until payment is received. If an account becomes more than 14 days delinquent, the school reserves the right to terminate enrollment, release the student’s classroom space, and refer the balance for collection. I understand tuition covers educational expenses only; therapy services (speech, OT, ABA, etc.) are billed separately through health insurance. Families without active insurance will be billed directly at the school’s cash rate. No records, assessments, or progress notes will be released until the account is paid in full.
8. Consent for Emergency Medical Treatment
In the event of an emergency, I hereby give permission to Anniston Academy staff to obtain emergency medical treatment for my child, including but not limited to transportation by ambulance, emergency room evaluation, and administration of necessary medications or procedures as determined by licensed medical professionals. I understand that every effort will be made to contact me or the individuals listed above before such action is taken. I also authorize the release of medical information to healthcare providers and emergency personnel as necessary to ensure the appropriate care of my child. I understand that I am responsible for all costs incurred as a result of medical treatment.
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I authorize the staff of Anniston Academy to seek emergency medical care for my child as needed. Reasonable efforts will be made to contact me prior to treatment unless a delay would jeopardize my child’s health or safety.
9. Therapy Animals on Campus
Anniston Academy is proud to incorporate therapy animals as part of our school community and therapeutic approach. These animals are carefully selected and trained to support students' emotional well-being, social development, and overall comfort in the school environment. Therapy animals may be present in classrooms, therapy spaces, and common areas during the school day. We ask all students, staff, and visitors to interact with them respectfully and follow any posted guidelines. If your child has allergies, fears, or other concerns related to animals, please notify the school in writing so we can make appropriate accommodations.
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I acknowledge that Anniston Academy may have therapy animals on campus as part of its educational and therapeutic programming. I understand that these animals are present to support student well-being. I agree to interact with them respectfully and will notify the school of any allergies, fears, or concerns related to animal presence.
10. Student Supply Fee & Enrollment Deposit
11. Acknowledgment of Risk
12. Waiver and Release of Liability
13. Family Volunteer Requirement
Effective September 2025, Anniston Academy requires each new enrolling family to contribute 20 volunteer hours per school year, divided into 5 hours per quarter. Families may choose from a wide range of opportunities, including classroom assistance, school events, fundraising, campus projects, and community outreach. Volunteer opportunities will be communicated regularly by email, and a log of hours will be maintained by the school. Opt-Out Option: Families who are unable to volunteer may choose to pay a $250 annual fee in lieu of completing hours. This requirement ensures that all families contribute—through time or resources—to the collective success of our school community.
Email of the Individual Submitting this Form
*
example@example.com
How did you learn about our program?
*
By signing below, I confirm that all information provided in this application is accurate and complete to the best of my knowledge. I understand that submission does not guarantee enrollment and that additional steps, including completion of all required release forms, may be necessary before my child can begin school.
*
You will be receiving emails from us over the next few weeks depending on any student needs you indicated in this application. Please complete these as soon as possible so that we are able to finish processing your student's application.
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