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.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year(s) Student Attended
*
Highest Grade Level Student Has Completed
*
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.
Format: (000) 000-0000.
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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.
*
PreK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Is your child repeating a grade level this year?
*
Yes
No
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.
What led you to explore Anniston Academy for your child? Why do you want your child to attend Anniston Academy?
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What are your primary goals or hopes for your child’s experience at Anniston Academy?
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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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Has your child ever experienced any disciplinary problems at a previous school?
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Yes
No
If yes, please explain.
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Behavior and Home Life
Who lives in the home with the child? Who is the child's primary caregiver?
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Has there been any significant family change (e.g., divorce, new sibling, move, loss)?
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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?
*
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.)
*
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?
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Health History
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.
Does your child have a history of concussions or other head injury? Has your child ever been diagnosed with a neurological condition (e.g., epilepsy, traumatic brain injury, migraines)? Does your child have a history of fainting, dizziness, or seizures?
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Yes
No
If yes, please describe when the injury or diagnosis occurred, any treatment received, and whether there are lingering effects (e.g., headaches, sensitivity to light/noise, balance issues, or academic impact).
Has your child ever been diagnosed with a genetic or metabolic disorder?
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Yes
No
If yes, please explain.
Does your child experience frequent headaches, fatigue, or sleep disturbances?
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Yes
No
If yes, please explain.
What therapeutic services does your student CURRENTLY receive?
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speech
feeding therapy
occupational therapy
ABA
behavioral or play 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?
*
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.
Does your child use any assistive technology at school or home (e.g., AAC device, tablet, specialized headphones)?
*
Yes
No
If yes, please explain.
Does your child take medication for a learning or behavioral issue?
*
Yes
No
If yes, please explain.
Does your child require emergency medication (e.g., EpiPen, inhaler, etc.)?
*
Yes
No
If yes, please explain.
Has your child ever been hospitalized, had surgery, a major infection, or major illness/injury?
*
Yes
No
If yes, please explain.
Was your child born full-term?
*
Yes
No
If no, please share gestational age, any NICU stay details, etc.
Any complications during pregnancy, delivery, or shortly after birth?
*
Yes
No
If yes, please explain.
Does your child have any allergies, dietary restrictions or special feeding requirements?
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Yes
No
If yes, please explain.
Does your child have any feeding or swallowing difficulties?
*
Yes
No
If yes, please explain.
Is your child a picky eater?
*
Yes
No
If yes, please explain.
Does your child have any gastrointestinal concerns (constipation, reflux, food aversions)?
*
Yes
No
If yes, please explain.
Does your child have any vision or hearing difficulties (wears glasses, hearing aids, sensory sensitivities)?
*
Yes
No
If yes, please explain.
Has your child had a recent vision screening?
*
Yes
No
If yes, what were the results?
Has your child had a recent hearing screening?
*
Yes
No
If yes, what were the results?
Does your child have any mobility limitations (uses braces, wheelchair, orthotics, etc.)?
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Yes
No
If yes, please explain.
Any noted challenges with balance, coordination, or fine motor skills?
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Yes
No
If yes, please explain.
Does your child seek or avoid sensory input (e.g., textures, noise, movement)?
*
Does your child have any fears, triggers, or situations that cause stress?
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Yes
No
If yes, please explain.
Approximate age your child sat unassisted?
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Approximate age your child crawled?
*
Approximate age your child walked?
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Approximate age your child walked?
*
Approximate age your child spoke first words?
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Approximate age your child formed sentences?
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Approximate age your child was toilet trained during the day?
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Approximate age your child was toilet trained at night?
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Is there any history of regression (loss of any skills)?
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Yes
No
If yes, please explain.
Are you willing to obtain additional support for your child should we recommend additional services?
*
Yes
No
If no, please explain.
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 yes, please explain.
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?
*
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:
*
Education Freedom Scholarship (EFS) (school voucher program)
Individualized Education Account (IEA) Program
Child Care Certificate
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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Signatures
Name of Individual Submitting this Application
*
First Name
Last Name
Email of the Individual Submitting this Application
*
example@example.com
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.
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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.
Signature: I acknowledge that I have read and understand Anniston Academy’s educational philosophy and inclusion policy. I understand that enrollment signifies agreement with this approach and that curriculum opt-outs are not permitted.
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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.
Signature: I acknowledge receipt and review of the Anniston Academy Parent Handbook, including policies related to student behavior, discipline, and school procedures. I understand and agree to the following: Anniston Academy uses a therapeutic, individualized approach to behavior. Access to related services, including but not limited to speech therapy, occupational therapy, and other therapeutic supports, is subject to provider availability, staffing, insurance participation, prior authorization, and clinical appropriateness. Anniston Academy and its affiliated entities, Coalesce Medical Services and Coalesce Social Services, do not guarantee the continuous availability of any specific related or medical service. Temporary or permanent interruptions in service availability may occur due to factors beyond the school’s control, including changes in staffing, insurance coverage, authorization status, provider capacity, or clinical determination. Such interruptions do not constitute a breach of enrollment, tuition agreement, or service obligation. My child may be subject to behavioral assessments, interventions, or redirection as needed to ensure safety and support development. 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 to support the creation of an effective plan. Repeated safety concerns or the inability to implement a supportive plan may result in modified attendance, temporary suspension, or disenrollment. I acknowledge that I was offered the opportunity for a building tour prior to official enrollment, and that I received the school’s written policies and summary of requirements. I understand I may request a tour at any time and that my acknowledgment of the handbook serves as confirmation that I have reviewed the school’s policies and procedures in full. I consent to my email being included in the Anniston Academy School Directory.
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3. Confidentiality, Proprietary Information, and Non-Compete Agreement
Initial: During the admissions and enrollment process, the Recipient may receive or be exposed to confidential or proprietary information belonging to the School. This information includes educational programs, therapeutic frameworks, staff qualifications, internal policies, operational procedures, and student-related examples. The Recipient agrees that such information is shared solely for the purpose of evaluating potential enrollment and shall not be copied, shared, or distributed.
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Initial: “Confidential Information” includes any verbal, written, or electronic communication, documentation, or materials not publicly available, including but not limited to: academic, therapeutic, or behavioral curricula; internal policies, procedures, and operational systems; employee or student handbooks; internal communications or correspondence; records, forms, or templates developed by Anniston Academy. Confidential Information does not include materials publicly released by the School through its official website or authorized publications.
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Initial: 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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Initial: The Recipient agrees to: maintain all Confidential Information in strict confidence; use it only for purposes directly related to the student’s application or enrollment; not reproduce, forward, or share it with any third party without written consent from the School; and return or permanently delete all materials upon request or withdrawal from the admissions process.
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Initial: The Recipient understands that Anniston Academy’s curriculum, therapeutic model, and operational systems are proprietary. Accordingly, the Recipient agrees that they shall not, during the admissions process or for two (2) years following withdrawal, denial, or completion of enrollment, either directly or indirectly: operate, establish, assist, or affiliate with any educational or therapeutic program—including private schools, microschools, homeschool cooperatives, tutoring centers, or clinics—that substantially replicates or uses Anniston Academy’s proprietary methods or materials within a 100-mile radius of the School’s campus; solicit, recruit, or attempt to hire any employee, contractor, or affiliate of Anniston Academy; encourage or solicit the withdrawal or transfer of any current or prospective student; or distribute or reproduce any curriculum, documentation, or policies obtained through the application or enrollment process for external use.
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Initial: Any violation of this section constitutes a material breach and may result in: immediate termination of enrollment or application; liquidated damages; the School’s right to seek injunctive relief and recovery of attorney’s fees and costs. Any unauthorized disclosure, disparagement, or competition may cause irreparable harm to the School. The School reserves the right to seek legal and equitable remedies, including injunctions, recovery of damages, and attorney’s fees.
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Initial: This Agreement remains in effect indefinitely with respect to any Confidential Information or statements made about the School, whether or not the student is ultimately enrolled.
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Signature: By signing below, I acknowledge that I have read, understood, and agree to the terms of this Non-Disclosure, Non-Disparagement, and Non-Compete Agreement.
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4. Non-Disclosure and Non-Disparagement Agreement
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.
Initial: This Agreement is entered into between Anniston Academy (“the School”) and the undersigned applicant parent(s)/guardian(s) (“the Recipient”) in connection with the admissions and enrollment process.
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Initial: During the application and enrollment process, the Recipient may receive or be exposed to confidential or proprietary information belonging to the School. This includes educational programs, therapeutic frameworks, staff qualifications, policies, internal procedures, and student examples or case discussions. The Recipient agrees that such information is shared solely for the purpose of evaluating potential enrollment and shall not be copied, shared, or distributed.
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Initial: “Confidential Information” includes any verbal, written, or electronic communication, documentation, or materials not publicly available, including but not limited to: academic or therapeutic curricula; internal policies or staff materials; student data, examples, or behavioral frameworks; non-public communications or operational processes. Confidential Information does not include materials publicly released through the School’s official website or social-media channels.
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Initial: The Recipient agrees to keep all Confidential Information strictly confidential; use it only for purposes directly related to the student’s application; not reproduce, forward, or share it with any third party without written consent from the School; and return or permanently delete any materials received upon request or withdrawal from the admissions process.
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Initial: 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 keeping with Anniston Academy’s commitment to transparency, collaboration, and problem-solving.
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Initial: I understand that maintaining a culture of mutual respect and professionalism is essential to the well-being of the entire school community.
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Initial: I further agree that any statement—verbal, written, or digital—that could reasonably be interpreted as defamatory, misleading, or damaging to the School’s reputation or staff shall constitute a breach of this Agreement. If such a breach occurs, I agree to issue an immediate written retraction using the same or equivalent medium of publication. Failure to uphold this agreement may result in termination of the application process or dismissal from the school community.
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Initial: Any unauthorized disclosure or disparagement may cause irreparable harm to the School. The School reserves the right to seek legal and equitable remedies, including injunctions, recovery of damages, and attorney’s fees.
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Initial: This Agreement remains in effect indefinitely with respect to any Confidential Information or public statements made about the School, whether or not the child is ultimately enrolled.
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Initial: Execution of this Agreement does not guarantee admission or imply acceptance for enrollment at Anniston Academy.
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Initial: By enrolling my child at Anniston Academy, I acknowledge that all school materials, programming, curriculum design, therapy integrations, operational systems, forms, policies, and procedures are the intellectual property of Anniston Academy and may not be copied, reproduced, shared, or used to create or support a competing program, school, service, or business. I agree that I will not use any part of Anniston Academy’s educational model, therapeutic structure, forms, documents, application processes, handbooks, policies, branding, or operational systems—whether in whole or in part—to develop, assist with, advise, or operate any competing childcare center, microschool, learning pod, therapeutic program, consulting service, private school, or educational venture within 100 miles, for a period of 5 years after enrollment ends. I further agree not to distribute or forward internal materials, training documents, manuals, or proprietary content to any third party without written authorization from Anniston Academy.I understand that violation of this clause may result in immediate disenrollment and/or further administrative action.
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Signature: I acknowledge and agree to communicate concerns or conflicts with Anniston Academy directly, respectfully, and in good faith. By signing below, I acknowledge that I have read, understood, and agree to the terms of this Non-Disclosure and Non-Disparagement Agreement.
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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.
Signature: I acknowledge that Anniston Academy embraces nature-based play, outdoor exploration, and hands-on learning as essential components of the school experience.
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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.
Signature
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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.
Signature: 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. No records, assessments, or progress notes will be released until the account balance is paid in full. I further understand that failure to pay any outstanding balance may result in my account being sent to collections.
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Signature: 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.
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Signature: Payments not received by the due date will incur a flat late fee of $50, and interest on the outstanding balance at 1.5% per month, beginning on the day the payment becomes delinquent. The school reserves the right to apply late fees and interest consistently and without additional notice.
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Signature: If tuition or fees become delinquent, the Parent/Guardian agrees to pay all costs of collection, including but not limited to collection agency fees, attorney’s fees, court costs, administrative fees, and allowable interest.
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Signature: Families experiencing financial hardship must notify administration before the account becomes past due. Failure to communicate does not exempt parents from fees or collection processes. The school may, at its discretion, offer temporary arrangements or accommodations; however, these are not guaranteed and must be approved in writing by administration.
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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.
Signature: 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.
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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.
Signature: 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.
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10. Student Supply Fee & Enrollment Deposit
Signature: I acknowledge that completion of this application does not guarantee my child's acceptance to Anniston Academy. I acknowledge that if accepted, I will be required to pay a $350 deposit per household to hold my child's spot for the upcoming school year. I further acknowledge that there will be a $50 student supply fee due by the first day of school. This fee helps cover the cost of basic classroom materials such as crayons, pencils, markers, glue, folders, and other commonly used supplies.
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11. Acknowledgment of Risk
Signature: I, the undersigned parent or legal guardian of the student named above, acknowledge that participation in academic, therapeutic, and extracurricular activities at Anniston Academy may involve inherent risks. These include, but are not limited to, physical activity, outdoor play, therapeutic interventions, field trips, transportation, and peer interactions. I understand that Anniston Academy and its affiliates (including Coalesce Social Services and Coalesce Medical Services, LLC), staff, and volunteers take all reasonable precautions to ensure a safe environment.
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12. Waiver and Release of Liability
Signature: In consideration of my child’s participation, I voluntarily assume all associated risks and agree to release, indemnify, and hold harmless: Anniston Academy, Coalesce Social Services (nonprofit sponsor), Coalesce Medical Services, LLC, and all affiliated staff, employees, agents, volunteers, and representatives from any and all claims, liabilities, damages, or causes of action arising from injury, illness, or harm to my child during school-related activities, including therapeutic services and behavior support. I understand that Anniston Academy is not responsible for lost, stolen, or damaged items brought to school by students or families.
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13. Family Volunteer Hours Requirement
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.
Signature: I have read and agree to the Anniston Academy Parent Volunteer Requirement. I understand that my family is responsible for completing 20 volunteer hours per school year (5 hours per quarter) or paying the $250 opt-out fee in lieu of volunteer service. I acknowledge that volunteer opportunities will be communicated regularly by email, and that a log of hours will be maintained by the school.
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14. DHS and DOE Regulations
Signature: I acknowledge that I have received a copy the applicable state child care and Department of Education regulations.
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15. Personal Safety Curriculum
As part of our state licensing requirements, all parents must be informed of the Personal Safety and Body Boundaries Curriculum taught at Anniston Academy. This is a state-provided curriculum developed by the Tennessee Department of Human Services to help children understand how to stay safe, recognize unsafe situations, respect personal boundaries, and know which trusted adults to turn to for help. This is not sex education and does not include sexual content. The lessons focus solely on personal safety and body awareness, using age-appropriate, trauma-informed instruction. The entire curriculum, “Keeping Kids Safe,” is attached for your review. Please take a few moments to look over the materials before completing the required acknowledgment. This form is required by the Tennessee Department of Human Services for all students enrolled in licensed programs.
Signature: I acknowledge that I have been provided an opportunity to review the agency’s personal safety curriculum, and have been notified of the sexual abuse/personal safety curriculum for my child.
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16. Influenza, MRSA, and Meningococcal Disease Acknowledgement
In accordance with Tennessee Department of Education and Department of Health requirements, Anniston Academy is required to provide families with the following health information annually. This notice is provided for informational purposes only in compliance with state law. I acknowledge I have received this information.
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17. Attendance Requirement
Regular attendance is required for continued enrollment at Anniston Academy. Repeated unexcused absences, chronic tardiness, or failure to communicate will result in administrative review. Students who do not meet attendance expectations may be dismissed from the program and their enrollment may be terminated at the discretion of administration.
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18. Transportation
I understand that Anniston Academy does not provide daily transportation. I am responsible for getting my child to and from school on time each day. Only individuals listed on my child’s approved pick-up list may transport them. Any changes must be submitted in writing. I understand that late pick-ups may result in fees or review of my child’s enrollment.
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How did you learn about our program?
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You will be receiving additional emails from us over the next few weeks regarding any specific student needs you indicated in your application. Please complete and return these forms as soon as possible so we can finalize processing your student’s application. Please note that we currently have an extensive waitlist, and timely completion of required forms is necessary to keep your child’s application active for consideration.
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