Enrollment Intake Form – Submitter & Student Information

Enter your information as the person submitting this enrollment intake form. You may complete this form for up to five students. Click the + icon on the far right to add each additional student.

Make sure to include the unique application number for each student, which is the student's last name plus their date of birth. This helps us match each child to their submitted application.  Example: Johnson03/25/2001

Submitter Information

Provide the contact details of the person responsible for submitting required documents on behalf of the student. This may be a parent, guardian, or authorized representative. The school will use this information to confirm document submissions, send reminders, and provide updates regarding document status.

Student Names

List the full legal name of each student you are applying for enrollment. Make sure each name matches exactly as it appears on the student’s birth certificate or other legal documents.

You may submit this form for up to five students. To add additional students, click the + icon on the far right of the student section. Each student will be processed individually using their unique application number, so it’s important that all names and details are entered accurately.

Be sure to include the unique application number for each student, which is the student’s last name plus their date of birth. This helps us accurately match each child to their submitted application.
Example: Johnson03/25/2001

Emergency Contact

Provide at least one emergency contact other than the primary parent or guardian. This individual will be contacted if we are unable to reach you during a medical emergency, early dismissal, or other urgent situation involving your child.

You may list up to three emergency contacts by clicking the + icon on the far right of this section. Be sure to include accurate and up-to-date phone numbers for each individual.

Authorized Pickup List

List all individuals who are authorized to pick up your child from school. For the safety of our students, only those listed here will be permitted to pick up your child unless prior written notice is provided to the school office. To add additional authorized individuals, click the + icon on the far right of this section. Make sure to include each person’s full name, relationship to the student, and a valid phone number.

Medical Information

Please provide accurate and up-to-date medical information for the student(s). This information helps us ensure your child’s safety and well-being while on campus and during school-sponsored activities.

In order to avoid submitting a separate form for each student, you may complete this section for multiple students in one submission, only if you do so carefully and in an organized format. This information is highly sensitive and must be accurate, reliable, and clearly matched to each student.

To do this, include the application number followed by the medical details, then separate each student’s information with a comma.
Example:
Johnson03/25/2001 – Peanut allergy,
Johnson06/10/2012 – Asthma (uses inhaler),
Johnson08/05/2015 – No known conditions

If this section is not completed clearly, we will require you to submit a separate form for each student. 

Standard Dismissal Method

Indicate how your child will normally be dismissed from school each day. This helps us maintain a safe and efficient dismissal process and ensures your child is released according to your authorized plan.If all students listed on this form share the same dismissal method, you may select one method and apply it to all. If different students have different dismissal routines, please select “Other” and clearly indicate each student’s dismissal plan using their unique application number.

Multiple-Students' Example:
Johnson03/25/2001 – School Bus,
Johnson06/10/2012 – Parent Pick-Up,
Johnson08/05/2015 – After School Program

If dismissal varies by day (e.g., different routine on Fridays), please include those details alongside each student’s entry.

Authorization and Attestation

By entering your full name below, you confirm that all information provided in this enrollment intake form is accurate and complete to the best of your knowledge. Your typed name will serve as your digital signature and official acknowledgment that the details submitted may be used to determine your student(s)’ enrollment eligibility and to support all required school documentation.

This digital attestation confirms that you understand your responsibility in providing truthful, complete, and up-to-date information.