Sunrise In-school Services Application
Child/Student Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Please Select
Male
Female
Other
School name (Contact office if not listed)
*
Please Select
Lamar Consolidated High School
Lamar Junior High School
Fulshear High School
Leaman Junior High School
Randle High School
Wright Junior High School
Terry High School
George Junior High School
Foster High School
Briscoe Junior High School
Grade/Level
*
Please Select
Prek
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
Parent/Guardian Full Name(s)
*
First Name
Last Name
Parent/Guardian 2 — Full Name and Relationship
First Name
Last Name
Contact Information
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Medical Insurance
*
Please Select
Commercial
Medicaid
Uninsured
Insurnace Plan
Id Number
Are you interested in the free tutoring program included with in-school services?
Yes
No
How did you hear about Sunrise Academy?
*
Please Select
School / Teacher / Counselor
Peachjar
Facebook
Instagram
TikTok
Google / Web Search
Friend / Family
Apartment / Community
Existing Sunrise Academy Family
Other
Additional Comments or Special Requests
*
*
*
*
*
*
Signature
Submit
Submit
Should be Empty: