Enrollment Application

Please complete all of the questions below. This is the first step in the enrollment process. If you meet the qualifications, we will contact you to proceed further.

PARENT/GUARDIAN INFORMATION

CHILD'S INFORMATION

Documents Required to Be Provided Before Start:

• Copy of recent IEP or 504 Plan (if applicable)

• Medical Clearance or physical

• Guardianship/Custody documentation (if applicable)

• Insurance Information (if applicable)

PARENT/GUARDIAN AGREEMENT

By submitting this form, I certify that the information provided is true and complete to the best of my knowledge. I understand that this is an initial intake form and additional documentation may be requested before enrollment is finalized.