Student Enrollment Form

Please complete the following in its entirety.

1) Student Information
2) Parent/Guardian Information
3) Emergency Contacts
4) Student Health Information - page 1
5) Student Health Information - page 2
6)Medication Form
7) Strengths - Challenges - Strategies
8) Student Interests
9) Student Documents
10) Student Records Release
11) Media Opt in/out Form
12) Sign and Submit

Student Information
Student*

First NameLast Name
Date of birth*

MonthDayYear
Date
Student's Ethnicity
Current Grade for 2024-2025 School Year:
Current School:
Please list all previous schools:
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Household Email*
Primary Household Number*

Area CodePhone Number
Campus

TempeLitchfield ParkQueen CreekGilbertScottsdaleOff-Campus Instruction (in-person)/Virtual Instruction

Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Address

Same as student
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Phone*

Area CodePhone Number
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 2*

First NameLast Name
Address

Same as student
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Phone*

Area CodePhone Number
Parent/Guardian 2 Email*
example@example.com
Additional information regarding Parent/Guardians:

Emergency Contacts
By submission of this form, ALL people listed below will have permission to pick up my child from school (photo ID required)

In the event of serious illness or injury occurring within the jurisdiction of AZ Aspire Academy, the school will first attempt to reach you and/or your physician. As parent/guardian, you consent to have your child receive first aid by facility staff and, if necessary, be transported to receive emergency care. You will be responsible for all charges not covered by insurance. You consent for the emergency contact person(s) I've provided to ACT ON MY BEHALF until I am available. I agree to review and update this information whenever a change occurs.
Emergency Contact 1*

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Emergency Contact 2*

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Physician Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number

Student Health Continued
Please list and describe student's developmental and/or learning disabilities*
i.e. ASD, ADHD, anxiety, dyslexia etc
Please list and describe student's sensory/environmental sensitivities*
i.e. noise, smells, touch etc
Please list therapies or interventions utilized past/present:*
i.e. occupational therapy, speech, tools, pencil grips etc

Medication Permission
Will any medications be administered during your child's school day? ( This includes emergency medication like an EpiPen)*

YesNo
If you answered YES to the question above please complete the attached form along with your physician.
Upload your completed Authorization to Administer Medicine Form here if applicable to your child

Browse Files

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Strengths - Challenges - Strategies

Please describe for each area of your child's development.
Social
Emotional
Physical
Math
Reading
Writing

Upload Student Documents
Student Name

First NameLast Name
Birth Certificate

Browse Files

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Current Immunization Records

Browse Files

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*In accordance with Arizona State Law, students must have proof of all required immunizations, or a valid exemption, in order to attend school. The immunization record must include the child's name, date of birth, and each vaccine dose must include the date and the name of the physician or health agency who administered the vaccine.

Student & Parent Handbook

Please read & Review our handbook below
Student and Parent Acknowledgement of Receipt of Handbook
I, ____________________, acknowledge and agree that I have received and read a copy of this handbook and have had ample opportunity to clarify any unclear policies with AZ Aspire Academy staff. I acknowledge and agree that any oral or written representations from AZ Aspire Academy representatives will not supersede the terms addressed in this acknowledgement. I also understand and acknowledge that AZ Aspire Academy reserves the right to modify, discontinue, or add policies and
procedures as it deems appropriate at any time. Although I will be advised of revised policies, AZ Aspire Academy does not require student or family acknowledgement or consent to enforce or discontinue the policies contained in this handbook. I have received a copy of the Student and Parent Handbook, and I accept responsibility for familiarizing myself with the policies and procedures it contains as a term of my admission to AZ Aspire Academy.
Parent/Legal Guardian Legal Name

First NameLast Name
Parent/Legal Guardian Relationship to Student
Mother, Father, Grandparent
Parent/Legal Guardian Signature

Clear
Student's Name

First NameLast Name
Student's Signature

Clear
Date

MonthDayYear
Date

Photography, Video, & Social Media Release for Student
Photography, Video, & Social Media Release for Student

I grant AZ Aspire Academy, its successors, and those acting with its permission authorization to use my child’s likeness in a photograph, video, or sound recording in any of the following ways (Please check all that apply):

Internal School Use: Posting within the school and through internal electronic communications (Hallways, classrooms, internal monthly newsletters to parents and staff, etc.)

Internal Training: For internal use such as staff training, internal emails highlighting best practices, etc.

External School Community: Posting on AZ Aspire Academy website, Facebook page, school marketing materials, etc.

External PR: Submitted to local news outlets and/ or publications outside of AZ Aspire Academy to promote events and curriculum at our school.

I do not want my child’s picture taken, unless it is for my child’s student file.

I understand and agree that these materials will become the property of AZ Aspire Academy and will not be returned. I waive the right to review, approve, or be compensated for these uses. I release AZ Aspire Academy from all claims and liabilities relating to the use of the Materials of my child, as set forth above.

AZ Aspire Academy will not identify my child’s full name without written consent. I understand that this approval can be revoked at any time by written request to my Campus Director and/ or my Outreach Coordinator.

AZ Aspire Academy has Social Media Policies in place for all of its schools and families. Please note that Parents may not post images of AZ Aspire Academy children (besides their own) to their personal social media accounts.
I grant AZ Aspire Academy, its successors, and those acting with its permission authorization to use my child’s likeness in a photograph, video, or sound recording in any of the following ways (Please check all that apply):

Internal School Use: Posting within the school and through internal electronic communications (Hallways, classrooms, internal monthly newsletters to parents and staff, etc.)Internal Training: For internal use such as staff training, internal emails highlighting best practices, etc.External School Community: Posting on AZ Aspire Academy website, Facebook page, school marketing materials, etc.External PR: Submitted to local news outlets and/ or publications outside of AZ Aspire Academy to promote events and curriculum at our school.I do not want my child’s picture taken, unless it is for my child’s student file.
Student Name

First NameLast Name
Parent Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Sign and Submit
You are submitting the following completed forms to AZ Aspire Academy:

1) Student Information
2) Parent/Guardian Information
3) Emergency Contacts
4) Student Health Information - page 1
5) Student Health Information - page 2
6)Medication Form
7) Strengths - Challenges - Strategies
8) Student Interests
9) Student Documents
10) Student Records Release
11) Media Opt in/out Form
12) Sign and Submit
Your first and last name *
Today's Date*

MonthDayYear
Date
Signature

Clear
Should be Empty:

Student Information

Parent/Guardian Information

Emergency Contacts

Student Health

Student Health Continued

Medication Permission

Strengths - Challenges - Strategies

Student Interests

Upload Student Documents

Student Records Release

USE AND DISCLOSURE INFORMATION:

Student & Parent Handbook

Photography, Video, & Social Media Release for Student

Sign and Submit

You are submitting the following completed forms to AZ Aspire Academy: