Summit Academy Admission Application

EDUCATION
List your child's previous schools, beginning with the most recent. If you need additional space, please use the comments section at the bottom of the form.
NAME OF CURRENT SCHOOL:
ADDRESS OF SCHOOL:
LIST ALL GRADES COMPLETED AT SCHOOL:
FIRST ATTENDED:

Month Day Year
LAST ATTENDED:

Month Day Year
NAME OF PREVIOUS SCHOOL:
ADDRESS OF SCHOOL:
FIRST ATTENDED:

Month Day Year
LAST ATTENDED:

Month Day Year
LIST ALL GRADES COMPLETED:
IS YOUR CHILD ELIGIBLE FOR RE-ENTRY AT CURRENT SCHOOL?

Yes No
HAS YOUR CHILD EVER BEEN RETAINED IN A GRADE?

Yes No
GRADE APPLYING FOR:
YEAR APPLYING FOR:

2021/2 2022/3 2023/4 Immediate Entry
WHAT QUALITIES ABOUT SUMMIT ACADEMY INTEREST YOU?
ARE YOU CURRENTLY CONSIDERING OTHER OPTIONS FOR ENROLLMENT?

EDUCATION
DO YOU INTEND TO HAVE YOUR CHILD COMPLETE ELEMENTARY SCHOOL AT SUMMIT ACADEMY?
WHICH SCHOOL DO YOU INTEND TO SEND YOUR CHILD TO AFTER SUMMIT ACADEMY? *
HAS YOUR CHILD EVER RECEIVED SPECIAL EDUCATION SERVICES (SPEECH, OCCUPATIONAL THERAPY, ETC.) *
HAS YOUR CHILD EVER RECEIVED OR BEEN RECOMMENDED TO RECEIVE AN EDUCATIONAL EVALUATION? *
HAS YOUR CHILD EVER BEEN SUSPENDED/EXPELLED FROM SCHOOL? *
IF YOUR CHILD IS A PRESCHOOLER, IS HE/SHE MEETING ALL DEVELOPMENTAL MILESTONES?
MAY WE THANK SOMEONE FOR REFERRING YOU TO US?

FATHER'S INFORMATION
FATHER'S NAME:

First Name Last Name
FATHER'S ADDRESS:

Street Address

Mailing Address:

City State / Province

Postal / Zip Code Country
PREFERRED EMAIL ADDRESS:
FATHER'S HOME NUMBER:
FATHER'S CELL PHONE #:
FATHER'S WORK#:
FATHER'S OCCUPATION:
FATHER'S EMPLOYER:
EMPLOYER'S ADDRESS:
MOTHER'S INFORMATION
MOTHER'S NAME:

First Name Last Name
MOTHER'S ADDRESS (IF DIFFERENT):

Street Address

Mailing Address:

City State / Province

Postal / Zip Code Country
PREFERRED EMAIL ADDRESS:
MOTHER'S HOME NUMBER:
MOTHER'S CELL PHONE#:
MOTHER'S WORK#:
MOTHER'S OCCUPATION:
MOTHER'S EMPLOYER:
EMPLOYER'S ADDRESS:
PARENT'S MARITAL STATUS:

MARRIED DIVORCED SEPARATED UNMARRIED
Please upload a copy of your child's passport page or birth certificate (proof of age required prior to enrollment)

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Kindly upload your child's most recent report card

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FINANCIAL INFORMATION
ARE YOU FINANCIALLY CLEARED FROM YOUR CHILD'S PREVIOUS SCHOOL? *
HAVE YOU REVIEWED SUMMIT'S TUITION SCHEDULE? *
PLEASE READ AND TICK TO SHOW YOU UNDERSTAND THE FOLLOWING POLICIES:

I HAVE READ THE TUITION SCHEDULE AND AGREE TO ABIDE BY THE DUE DATES FOR TUITION IF I ENROLL MY CHILD, I UNDERSTAND THAT I MUST GIVE THE SCHOOL ONE TERM'S NOTICE WHEN WITHDRAWING OR PAY ONE TERM'S FEE IN LIEU OF NOTICE I UNDERSTAND THAT TUITION IS NOT REFUNDED FOR STUDENTS WHO LEAVE EARLY IN THE TERM
NAME OF PERSON COMPLETING THIS FORM:

First Name Last Name
Should be Empty:

STUDENT'S INFORMATION