Application for New Students

Student / Child's Full Name

Date of Birth

Child’s Gender

Male
Female

Child's Age on August 1, 2024

Home Address

City

State

Zip Code

Primary Phone Number

Primary E-Mail

Student lives with (check all that apply)

Father

Mother

Step Father

Step Mother

Guardian

Release information to (check all that apply)

Father

Mother

Stepfather

Stepmother

Guardian

What's the primary language spoken in the home?

Any other language spoken in the home? To what extent?

Sibling Information (if applicable)

Name

Age

Grade

School

Relationship to Child

Name

Address

City

State

Zip Code

Cell Phone

Work Phone

Occupation

Employer

E-Mail

Relationship to Child

Name

Address

City

State

Zip Code

Cell Phone

Work Phone

Occupation

Employer

E-Mail

How did you hear about Discovery School?

Person responsible for the tuition payment

Today's Date:

Toddler Program: 18 months - 3 Years Indicate Choice

8:30 AM - 11:30 AM (Half Day)

8:30 AM - 3:00 PM (Full Day)

Early Childhood Program: 2.5 Years - 6 Years Indicate Choice

8:15 AM - 11:30 AM (Half Day Ages 2.5-4)

8:15 AM - 3:15 PM (Full Day Ages 2.5-6)

Elementary: Grades 1-6 Indicate Choice
Please submit school records (transcript, report cards, progress reports, test results) for the last two years with applications for elementary

Grade:

Extended Day (if available) Indicate Choice

Physician's Name

Physician Address

City

State

Zip Code

Physician's Phone

General Health of the Child

Date of Last Physical

Date of Last Hearing Test

Date of Last Vision Test

Date of Last Dental Exam

Physical Limitations

Is your child taking any medications on a regular basis?

No
Yes

If Yes, Please Explain

School Previously Attended

Address

Dates Attended

Additional School Previously Attended

Address

Dates Attended

Reason for Leaving

Has your child ever been dismissed from school for any reason?

No
Yes

If Yes, Please Explain (include school and principal name)

Are there areas where your child may have exceptional strengths?

No
Yes

If Yes, Please Elaborate

Has your child had delays in meeting any developmental milestones?

No
Yes

If Yes, Please Elaborate

Does your child receive therapy services?

No
Yes

If Yes, What type of therapy services and how often?

Does your child have any clinically diagnosed learning differences?

No
Yes

If Yes, What diagnosis and when was he/she diagnosed?

Has your child ever had psychological counseling?

No
Yes

If Yes, please explain. This WILL NOT become a part of the student's permanent record.

Please use the space below for any other pertinent information about the child or family situation (optional).

Parent’s Acknowledgement of Risk & Personal Responsibility

“I acknowledge that I have freely chosen to enroll my child(ren) at Discovery School for the 2024-25 school year.  I understand that Discovery School has taken all reasonable precautions to protect parents, students, and staff from exposure to COVID-19.  Those measures include but are not limited to appropriate screening of families and staff, temperature measurement, face masks, social distancing, and enforcement of proper hygiene and sanitization.  These and other preventive measures will be implemented at the school’s discretion. 
 
I am permitting my child(ren) to participate in school activities and programs at Discovery with this understanding and hereby knowingly and voluntarily assume all risks of injury, illness, death, or damage related to COVID-19, which may arise as a result of my child’s voluntary participation and attendance of Discovery School.  I accept full responsibility for all medical expenses for any injuries or exposure my family might receive by reason of my child’s attendance.  

I further acknowledge that my child’s attendance may expose my family to COVID-19 in spite of the above measures, and I assume any such risk, thus releasing Discovery and all its agents from liability.  I may discontinue my child’s attendance at any time in light of the risks I am assuming hereunder, while acknowledging that this attendance in no way impacts or releases me from my contractual enrollment agreement. 
										
I also agree that by attending Discovery School, my family will fully comply with all such measures out of respect for the safety and health of the teachers and the larger school community.  I agree to abide by all safety precautions outlined in the above commitment, to the fullest extent possible, when in public spaces outside of school.”

Parent/Guardian # 1: Type your full name below to agree to the above acknowledgement of risk & personal responsibility:

Parent/Guardian # 2: Type your full name below to agree to the above acknowledgement of risk & personal responsibility:

Application Signing & Acknowledgement

By submitting this application, I certify that all of the information provided is complete and accurate to the best of my knowledge. I confirm that I have legal custody of the child who is applying to attend The Discovery School.

Name of Person Submitting Application (Parent/Guardian)

Date

Signature