We cant wait to welcome you “home”. Name * First Name Last Name Email * Will be used to send out updates Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How many days are you interested in? * OPTIONS 2- Day ( M /W ) 2-Day (T/Th) 3-Day ( M/W/F, or W/Th/F) 4-Day (Mon- Thur) 4-Day (Tue-Fri) 5-Day (M-F) Preferred Date for 1-on-1 Call MM DD YYYY Time Hour Minute Second AM PM Child's #1 name * Child's D.O.B MM DD YYYY Allergies or Medication? If yes please list all allergies * Child #2 name Childs D.O.B MM DD YYYY Allergies or Medication? If yes please list all allergies Child #3 name Childs D.O.B MM DD YYYY Allergies or Medication? If yes please list all allergies What curriculum or learning style have you used in the past? * What are your child’s academic strengths? * What subjects does your child need the most support in? * Does your child have any diagnosed learning differences or special needs? * Are there accommodations that help your child learn best? * How does your child handle transitions or new environments? * Are there specific goals you have for your child this year? * How would you describe your child’s personality in group settings? * How does your child express excitement, frustration, or stress? * What helps your child feel safe and successful in a learning space? * What is your Childs favorite activities or interests? * Every family is unique in how they recognize birthdays and holidays. Does your family celebrate these occasions? If not, how would you like us to support and include your child during these times? * Please use this section to provide any additional information you would like us to know about you and your family. * Thank you!
