2026-2027 Hybrid Program Application

2026-2027 Hybrid Program Application
Thank you for your interest in Creation Acres!

This form is for families applying to our Hybrid Program for students ages 5 to 15, meeting on Tuesdays and Thursdays at 9am-2pm, beginning on September 8th, 2026.
Student Information
Number of Students*
Student 1
Student 1 Name*

First NameLast Name
Student 1 Birth Date*

MonthDayYear
Date
What grade is your child entering in 2026-2027?*
Describe your child's personality, and tell us anything we should know that will help us to best serve him/her.*
Tell us about your child’s experience in group learning environments (co-ops, classes, teams, church groups, previous schools, etc.). What has gone well, and what has been challenging?*
Does this student have a diagnosis, developmental delay, or behavioral challenges that our team should know about? If so, how does this show up?*
Previous Non-Parental Teacher Contact Info

If applicable, please share the contact information for your child’s current or most recent non-parental teacher so that we may reach out for helpful perspective on your child as a learner.
Teacher's Name
Teacher's Email Address
In what capacity did this teacher work with your child (subjects taught and time frame)?
Student 2
Student 2 Name

First NameLast Name
Student 2 Birth Date

MonthDayYear
Date
What grade is your child entering in 2026-2027?
Describe your child's personality, and tell us anything we should know that will help us to best serve him/her.
Tell us about your child’s experience in group learning environments (co-ops, classes, teams, church groups, previous schools, etc.). What has gone well, and what has been challenging?
Does this student have a diagnosis, developmental delay, or behavioral challenges that our team should know about? If so, how does this show up?
Previous Non-Parental Teacher Contact Info

If applicable, please share the contact information for your child’s current or most recent non-parental teacher so that we may reach out for helpful perspective on your child as a learner.
Teacher's Name
Teacher's Email Address
Student 3
Student 3 Name

First NameLast Name
Student 3 Birth Date

MonthDayYear
Date
What grade is your child entering in 2026-2027?
Describe your child's personality, and tell us anything we should know that will help us to best serve him/her.
Tell us about your child’s experience in group learning environments (co-ops, classes, teams, church groups, previous schools, etc.). What has gone well, and what has been challenging?
Does this student have a diagnosis, developmental delay, or behavioral challenges that our team should know about? If so, how does this show up?
Previous Non-Parental Teacher Contact Info

If applicable, please share the contact information for your child’s current or most recent non-parental teacher so that we may reach out for helpful perspective on your child as a learner.
Teacher's Name
Teacher's Email Address
Student 4
Student 4 Name

First NameLast Name
Student 4 Birth Date

MonthDayYear
Date
What grade is your child entering in 2026-2027?
Describe your child's personality, and tell us anything we should know that will help us to best serve him/her.
Tell us about your child’s experience in group learning environments (co-ops, classes, teams, church groups, previous schools, etc.). What has gone well, and what has been challenging?
Does this student have a diagnosis, developmental delay, or behavioral challenges that our team should know about? If so, how does this show up?
Previous Non-Parental Teacher Contact Info

If applicable, please share the contact information for your child’s current or most recent non-parental teacher so that we may reach out for helpful perspective on your child as a learner.
Teacher's Name
Teacher's Email Address

Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*
How did you hear about us? (Other)
Why do you believe this program is a good fit for your family?*

Application Fee (Non-Refundable)

One Student

$50.00

Multiple Students (Family Rate)

$100.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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2026-2027 Hybrid Program Application

Student Information

Student 1

Student 2

Student 3

Student 4