Student Enrollment Please enable JavaScript in your browser to complete this form.Child InformationChilds Name *FirstLastChilds Date of Birth *Parent 1 InformationParent 1 Name *FirstLastParent 1 Date of Birth *Parent 1 Home Phone Number *Parent 1 Email Address *Parent 1 Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent 1 Employer Name *Employment AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent 1 Employer Phone Number *Parent 1 Social Security Number *Parent 2 InformationParent 2 NameFirstLastParent 2 Date of BirthParent 2 Address (if different from Parent 1)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent 2 Employer NameEmployment AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent 2 Employer Phone NumberParent 2 Social Security NumberAdditional InformationMarital Status *Please ChooseMarriedSeparatedDivorcedNot ApplicableCustody Arrangements, if anyFile UploadPlease provide legal document, if required.Emergency Contact Names and Phone Numbers (must be different from parents) and have your permission to pick up your child.#1 *FirstLast#1 Phone *#2 *FirstLast#2 Phone *We will always call you first at all numbers listed. Please indicate numerically who should be called next.Please List any individual NOT permitted to pick your child up belowList NamesPlease Answer All QuestionsMake and model of your vehicle *License plate number *Names and ages of siblingsGeneral Information About ChildPhysician Name *FirstLastPhysician Phone Number *AllergiesPlease List Any MedicationsPrevious SchoolGrade CompletedWas your child enrolled in speech, special needs, or basic skills? *YesNoIf Yes, Please DescribeDoes Your Child Have An IEP? *YesNoIf Yes, Please DescribeDoes your child speak fluent English? *YesNoIf not, what language(s) does your child speak?What language is spoken at home? *EnglishSpanishMandarinArabicHindi/UrduFrenchRussianOtherHow did you find out about Highland Academy? *Family/FriendInternet SearchTVPrint AdRadioOtherWhy do you want your child to go to private school? *I hereby attest that all information is factual and correct, I also agree to the Highland Academy II Privacy Policy & Terms of Service.Consent *I AgreeMessageSubmit
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