Student Enrollment Form

Student Enrollment Form

Complete the form for your child’s K–3 enrollment for the 2027–2028 school year, including required documents and consent for screening.
Student Information
Child's Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current School
Current Grade
Grade Entering for the 2027–2028 School Year
Parent/Guardian Information
Parent/Guardian Name

First NameMiddle NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Communication

Other
Additional Parent/Guardian Information
Emergency Contacts
Emergency Contact 1 Name

First NameMiddle NameLast Name
Emergency Contact 1 Relationship
Emergency Contact 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 Authorized to Pick Up
Emergency Contact 2 Name

First NameMiddle NameLast Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Authorized to Pick Up
Authorized Pickup
Authorized pickup contacts
Acknowledgment
Instructions
Pickup authorization notes
Custody Information
Are there any custody agreements or court orders?
If yes, please explain the custody arrangement and any pickup restrictions
Upload supporting custody or court documents

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Medical Information
Doctor's Name

First NameLast Name
Doctor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Hospital
Does the student have any allergies?
Allergy Details

Other
Upload Allergy Details or Documentation

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Does the student have any medical conditions?
Upload Medical Condition Details or Documentation

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Dietary Restrictions

Other
Emergency Care Instructions
Required Documents
Current Physical Examination

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Immunization Record

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IEP, 504 Plan, and Student Support
Does the student have an Individualized Education Program (IEP)?
Does the student have a Section 504 Plan or other support plan?
Student support services and documents
Academic Information
Academic strengths

Other
Areas needing additional support

Other
Reading ability
Math ability
Has the student repeated a grade?
Attendance concerns

Other
Other information the school should know
Academic Screening and Placement Assessment
Incoming students participate in an academic screening assessment to help Elite Scholars Academy identify current academic strengths, areas needing support, and appropriate instructional placement.
Do you give consent for your child to participate in the academic screening assessment?
Social, Emotional, and Behavioral Information
Are there any current behavioral concerns we should know about?
Please describe the behavioral concerns
What types of support does the student benefit from?

Other
Does the student have difficulty with transitions or changes in routine?
Upload any behavior support plans, reports, or related documents

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Please share strategies that work well when supporting the student
Permissions
Consent to emergency medical treatment
Consent to local field trips
Consent to student technology use
Consent to photographs
Consent to videos
Consent to school website use
Consent to social media use
Consent to marketing materials use
Preferred communication methods
Family Information
How did you hear about Elite Scholars Academy?
Why are you interested in enrolling your child at Elite Scholars Academy?
What do you hope your child will gain from attending Elite Scholars Academy?
Are you interested in volunteering with the school?

Other
Parent Agreements
Parent Handbook Acknowledgment
Attendance Expectations Acknowledgment
Student Conduct Expectations Acknowledgment
Tuition and Fee Policy Acknowledgment
Information Accuracy and Update Responsibility
Enrollment Acknowledgment
Electronic Signature
Parent/Guardian Full Legal Name

First NameMiddle NameLast Name
Relationship to Student
Electronic Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Student Enrollment Form

Student Information

Parent/Guardian Information

Emergency Contacts

Authorized Pickup

Custody Information

Medical Information

Required Documents

IEP, 504 Plan, and Student Support

Academic Information

Academic Screening and Placement Assessment

Social, Emotional, and Behavioral Information

Permissions

Family Information

Parent Agreements

Electronic Signature