Whole Kids Academy Kindergarten Admissions Application

Application for K-3 Admission

2026-27 Academic Year
- Child Name*
  
  First NameMiddle NameLast NameSuffix
- Preferred Name
  Preferred Name at School
- Gender*
- Birthdate*
  
  MonthDayYear
- Child's Picture*
- T-Shirt Size*
- How did you hear about us?*
- What grade are you applying to?
- Parent/Guardian Contact #1
- Name*
  
  PrefixFirst NameLast NameSuffix
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Primary Phone*
  
  Area CodePhone Number
- Alternate Phone*
  
  Area CodePhone Number
- E-mail*
  example@example.com
- Parent/Guardian Contact #2
- Name
  
  PrefixFirst NameLast NameSuffix
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Primary Phone
  
  Area CodePhone Number
- Alternate Phone #2
  
  Area CodePhone Number
- E-mail
  example@example.com
- Emergency or Alternate Contact
- Name*
  
  PrefixFirst NameLast Name
- Relation*
- Primary Phone*
  
  Area CodePhone Number
- Alternate Phone #1*
  
  Area CodePhone Number
- Pickup Authorization
  
  Please list the name/names of all persons authorized to pick up your child.
- Name*
- Phone Number*
  
  Area CodePhone Number
- Name*
- Phone Number*
  
  Area CodePhone Number
- Name
- Phone Number
  
  Area CodePhone Number
- Name
- Phone Number
  
  Area CodePhone Number
- What is your neighborhood school or which private school do you plan to send your child after WKA?*
- Did your child attend preschool at WKA?*
  
  YesNo
- Please describe your child's experience and ability level to comprehend and speak Spanish.*
- Does your child have any special needs? (academic, nutritional, emotional, social, etc.)*
  
  YesNo
- Please describe your child's special needs.*
  Academic, nutritional, emotional, social, etc.
- Does your child have an Individualized Education Program (IEP) or a 504 Plan?*
  
  YesNo
- Please share more about your child's Individualized Education Program (IEP) or 504.*
- What are your primary academic goals for your child this school year?*
- In what ways will your family plan to support your child's academic goals at home?*
- How does your child learn best?*
- How would you describe your child?*
- How does your child handle transitions?*
- How does your child handle conflict or frustration? (what do you typically see?)*
- How would you describe your child’s energy level? (high/steady/slow to warm up)*
- What is one thing you wish your child’s teacher understood about them from day one?*
- Allergies and Medications
- This child is allergic to*
  
  No known allergiesFoodMedicineThe environment (insect; stings; hay fever etc.)
- Please describe the allergy and possible reactions
- For food allergies, please indicate the specific allergy type
  
  IngestedInhaledContact
- Does your child have an allergy action plan and/or epi-pen?
  
  YesNo
- Immunization History
- Are all immunizations up to date, according to CDC guidelines? (Please note, all immunizations must be up to date prior to the first day of school.)*
  
  YesNo
- Please explain why your child's immunizations are not up to date.
- Most Recent Tetanus shot (Month/Year)*
- If this student is exempt from any immunizations due to medical contraindication or religious reasons, please note here.
- Medical Insurance Information
- My child is covered by family medical/hospital insurance*
  
  YesNo
- Health Care Providers
- Name of child's primary doctor*
- Doctor's phone number*
  
  Area CodePhone Number
- Name of child's dentist*
- Dentist's phone number*
  
  Area CodePhone Number
- Medication
- Does your child take any medications AT HOME?*
  
  YesNo
- AT HOME Medication/Dosage/Frequency*
- Will you be providing PRESCRIPTION medications (including emergency medications such as Epipens or asthma inhalers) for our program to administer during the day?*
  
  YesNo
- AT SCHOOL Medication/Dosage/Frequency*
- If yes to the above question, a completed Medication Authorization Form needs to be on file with the administration's office. A physician's order and a parent/guardian signature are required before prescription medicine is dispensed. The Medication Authorization Form will be included in our admissions packet.
- Restrictions/Conditions
- Restrictions*
  
  My child can participate in all school day activities without restrictionsMy child can participate in school day activities with some restrictions or adaptations
- Please describe restrictions or adaptations*
- Are there any other health problems including past medical treatment or physical, psychiatric, or behavioral problems that may affect the student's ability to fully participate in school day activities?*
  
  YesNo
- Please explain any other issues that may affect the student's ability to fully participate in school day activities?*
- Whole Kids Academy/Whole Kids After School has my permission, when I cannot be contacted, to provide emergency medical attention and, if necessary, take my child at my expense to the nearest hospital's emergency room. The hospital and its medical staff have my authorization to provide treatment that is deemed necessary for the well-being of my child.
- By signing and completing this admissions application, I confirm my intent for my child to attend WKA's Kindergarten - 3rd grade program for the 2026-27 academic school year, beginning on August 24, 2026 - June 16, 2027 (dates to be confirmed with the 2026-27 School Calendar). Upon acceptance to the program I understand I will have two weeks to confirm my child's spot and make payment arrangements for tuition and fees. (Registration, books and materials $850, annual tuition is $24,200, with bi-weekly payment options available).*
  
  Yes, I agree to register my child for WKA's Kindergarten - 3rd grade program and confirm that the information I have provided above is complete and accurate.
- Name*
  
  First NameLast Name
- Signature*
- Additional Comments:
What are your child's favorite interests or activities right now?*
Should be Empty:

Application for K-3 Admission

Parent/Guardian Contact #1

Parent/Guardian Contact #2

Emergency or Alternate Contact

Pickup Authorization

Allergies and Medications

Immunization History

Medical Insurance Information

Health Care Providers

Medication

Restrictions/Conditions