Name(s) of Primary Parent(s) or Legal Caregiver(s)*

Are there legal documents concerning custodial restrictions? If so, please upload them in their entirety or render a printed copy.*

Do you have a legal right to register the following children for school? By filling out this form, you agree that all answers are true. *

Primary Guardian's Email*

Mother's Email*

Father's Email*

Primary Guardian's Phone Number*

Mother's Phone Number*

Father's Phone*

Home Mailing Address*

First Child's Full Name *

First Child's Birthday*

Where does the First Child Live?*

Any allergies or restrictions for the FIRST Child?*

Tell us about your First Child. We would love to know about his/her likes and dislikes, preferences, challenges and specialties. *

What school(s), if any, has your First Child previously attended?*

Please note any behavioral issues that your First Child has faced in former schools. Passed misbehavior does not disqualify your child from trying out our microschools, but failing to disclose behavior problems will. We will call each school.*

Second Child's Full Name

Second Child's Birthday

Where does the Second Child Live?

Any allergies or restrictions for the SECOND Child?

Tell us about your SECOND Child. We would love to know about his/her likes and dislikes, preferences, challenges and specialties.

What school(s), if any, has your SECOND Child previously attended?

Please note any behavioral issues that your Second Child has faced in former schools. Passed misbehavior does not disqualify your child from trying out our microschools, but failing to disclose behavior problems will. We will call each school.

Third Child's Full Name

Third Child's Birthday

Where does the Third Child Live?

Any allergies or restrictions for the THIRD Child?

Tell us about your THIRD Child. We would love to know about his/her likes and dislikes, preferences, challenges and specialties.

What school(s), if any, has your THIRD Child previously attended?

Please note any behavioral issues that your THIRD Child has faced in former schools. Passed misbehavior does not disqualify your child from trying out our microschools, but failing to disclose behavior problems will. We will call each school.

Fourth Child's Full Name

Fourth Child's Birthday

Where does the Fourth Child Live?

Any allergies or restrictions for the FOURTH Child?

Tell us about your FOURTH Child. We would love to know about his/her likes and dislikes, preferences, challenges and specialties.

What school(s), if any, has your FOURTH Child previously attended?

Please note any behavioral issues that your FOURTH Child has faced in former schools. Passed misbehavior does not disqualify your child from trying out our microschools, but failing to disclose behavior problems will. We will call each school.

Fifth Child's Full Name

Fifth Child's Birthday

Where does the Fifth Child Live?

Any allergies or restrictions for the FIFTH Child?

Tell us about your FIFTH Child. We would love to know about his/her likes and dislikes, preferences, challenges and specialties.

What school(s), if any, has your FIFTH Child previously attended?

Please note any behavioral issues that your FIFTH Child has faced in former schools. Passed misbehavior does not disqualify your child from trying out our microschools, but failing to disclose behavior problems will. We will call each school.

EMERGENCY CONTACT: NAME AND NUMBER of person who you give permission to pick up your child without question*

EMERGENCY CONTACT: NAME AND NUMBER of person who you give permission to pick up your child without question*

EMERGENCY CONTACT: NAME AND NUMBER of person who you give permission to pick up your child without question*

Please upload all the birth certificates, immunization forms, immunization exemption forms and prescriptions (when medication must be given on campus) for every child.

Upload File

What questions or concerns do you have?*

Submit