Student Enrollment Form

Address

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 Name Last Name
Phone Number

- Area Code Phone Number
Relationship
Emergency Contact 2 *

First Name Last Name
Phone Number

- Area Code Phone Number
Relationship
Physician Name

Address

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
Please complete and submit the Student Health and Medication Form below.
Student Health and Medication Form
Upload the completed students health and medication form along with any other related medical documentation.

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Cancel of

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 Name Last Name
Birth Certificate

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Cancel of
Current Immunization Records

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Cancel of
*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.

Media Opt in/out Form
Part of the communication efforts of AZ Aspire Academy is to let the general public know about the educational activities occurring within the walls of our schools. As part of that effort, we also occasionally invite reporters to the schools to cover educational activities and events. The main focus of education, of course, is students, and during the vast majority of time, we and the media will want to focus on students as the subject of stories. For that reason, we are seeking your permission ahead of time for your student(s) to be interviewed, photographed or videotaped in the event such an opportunity surfaces during the school year. This will include the use of that material on the school website and social media managed by AZ Aspire Academy. Please note, AZ Aspire Academy policy prevents use of a child’s full name in association with their photo or video in any form of use.
If you DO NOT want your student to be involved in one or all of these instances, please fill out this form. Please note, your permission will be assumed if the school does not receive this form.
Please indicate which instances you would like to opt out of:

My child may NOT be photographed or videotaped, for use by AZ Aspire Academy. My child may NOT be photographed, videotaped and interviewed by an outside entity
Student Name

First Name Last Name
Parent Name

First Name Last Name
Parent/Guardian Signature

Clear
Date

- Month - Day Year
Date

Student Information