2023/2024 New Student Enrollment Application

Student Name

Student Date of Birth

Primary Address

Enrollment Option

Parent/Guardian Information

Complete for any custodial parents/guardians.

Primary Parent/Guardian

Name

Cell Phone

Add to Text List?

Email Address

This address will receive a confirmation email

Add to Email List?

Preferred Method of Contact

Text Call Email

Occupation/Employer

Parent/Guardian 2 (skip if not applicable)

Name

Cell Phone

Add to Text List?

Email Address

Add to Email List?

Occupation/Employer

Parent/Guardian 3 (skip if not applicable)

Name

Cell Phone

Add to Text List?

Email Address

Add to Email List?

Occupation/Employer

Parent/Guardian 4 (skip if not applicable)

Parent/Guardian 4 Name

Cell Phone

Add to Text List?

Email Address

Add to email list?

Occupation/Employer

Family Information

Parent Status: Check all that apply

Married Divorced Widowed Separated/Not Together Mom Remarried Dad Remarried Single Mom Single Dad Adoptive (student is adopted)

Name of Home Church

Academic History

Please complete all applicable fields as it pertains to your child's previous education.

All records will need to be submitted to Streams of Hope prior to admission.

Public or Private School 1 (skip if not applicable)

Please list the names of any public or private schools attended:

Please list the grade levels attended for each school listed above

Homeschool Information (skip if not applicable)

Grade Level/Year(s)

Last Grade Completed

Curriculum Used:

Academic Needs/Concerns

Has your child had an IEP/ISP/504 or have they been diagnosed with a learning disability?

If your child has/had an IEP/ISP/504, will they continue to be supervised by a public school Special Education Liason?

We need a complete and accurate picture of your student's academic ability to determine if we are able to meet their needs. If your student has an IEP/ISP/504, please submit these records via email to jill_haskins@streamsofhopeacademy.com prior to your child's diagnostic assessment.

I acknowledge that the answers above are complete and accurate.

Yes No

What is your student's favorite subject?

What is your student's least favorite subject?

What is your child's learning style? (choose all that apply)

Hands On/Kinesthetic Individual/Self Motivated Auditory Visual Group/Partners Project Based

What are your student's hobbies and interests?

Medical Information

List any medical conditions your child has been diagnosed with (including mental health):

List all seasonal and/or food allergies and what reactions:

Does your child need a medication at school? (epipen, anxiety medication, rescue inhaler, etc)

Please list any current medications your student takes:

Does your child have any social/behavioral needs?

Is there anything else we need to know about your student?

Emergency Information

In case of an emergency where the primary parent or guardian cannot be reached, please list an emergency contact other than yourself (over the age of 18).

Emergency Contact Name:

Phone:

Relationship to the student:

Please list the names of people who are authorized to pick up your student:

Photo Release

Publicity Waiver: I recognize that Streams of Hope Christian Academy uses photographs and video images of events on their school/church (Heartland Church) website and social media outlets. I hereby grant permission for photo/video images of my child to be taken and used for such purposes.

Photo and Video images may be used on the school/church websites and social media outlets.

General Information

How did you hear about Streams of Hope Christian Academy?

Would you be interested in teaching an afternoon class?

Would you be interested in volunteering in the classroom or at special events?

Yes- Classroom Yes- Special Events No, thank you

I have read and agree to the Streams of Hope Student Guidebook, Discipline Policy, and Attendance Policy.

I confirm that the above information is true, complete, and accurate.

Application Fees $150

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

To complete the enrollment process:
1. Complete this registration form and submit payment upon completion.
2. Submit all formal and informal educational records.
3. Complete the student diagnostic test ($45 fee applies- The Executive Director will call to schedule this)
4. After all records and assessments have been completed, the Executive Director will call with enrollment determination.
5. If accepted for enrollment, submit August tuition ($325 half day and $400 full day) and $50 technology fee ASAP.

Please email jill_haskins@streamsofhopeacademy.com with any questions or concerns you have about the enrollment process.

2023/2024 New Student Enrollment Application

Description

Please Fix the Following