New Hope Academy

Uniting Traditional Schooling and Homeschooling For A Blended Learning Experience.

Personal Information: Student

Family Name: Given Name: Middle Name: Preferred Name: Date of Birth (Day/Month/Year):

Sex: Male Female

Has the child applied for admissions to this academy previously? Yes No

Personal Information: Family

Parent/Guardian 1 Family Name: First Name: Mobile:

Parent/Guardian 2 Family Name: First Name: Mobile:

Home Address (Correspondence will be sent here): Home Phone: Email:

School History: Student

At what age did the child start formal schooling?

Last 2 Schools Attended

1. School Name: Address: Dates: From (Month/Year) To (Month/Year) Grade/Class: Month Academic Year Began:

2. School Name: Address: Dates: From (Month/Year) To (Month/Year) Grade/Class: Month Academic Year Began:

Please indicate the last grade/class completed in full: Date of Completion (Day/Month/Year): Type of curriculum (if known): Please list the child’s particular interests/talents or school activities: Has the child ever been suspended or requested to withdraw from a school? Yes No If yes, please explain: Has the child’s educational program ever been modified for any of the following reasons? (Check all that apply) Behavioural Academic Gifted/Talented If yes, please explain: Does the child currently receive any special educational assistance? Yes No If yes, please explain: Has the child ever been tested by a Learning Specialist or Psychologist? Yes No If yes, please explain and attach records: Does the child have any medical or physical disabilities? Yes No If not provided above, please explain:

Parent Employment Information

Name of Company: Position: Company Address: Work Phone: Work Fax: Work Email:

Tuition Rate Information

Payment by Parent

Required Documentation for Admission

Application Form
Copy of child's Birth Certificate
Submit recent photos for record keeping
Completed Medical Emergency form
Copy of Vaccination Records or Non-vaccinator form
Completed NHA Admission form
Any other forms submitted by the academy

Application

Application forms should be submitted by August 1st along with Curriculum Contributions as spaces are limited in many grade levels.

The application cannot be processed until the one-time, non-refundable application fee is received.

Agreement Between the Academy & Parents/Guardians

I/we desire to enroll as a student at New Hope Academy, Portland, Ohio.

I/we agree to understand, accept, and support the Philosophy and Mission of the Academy and be bound by the rules governing the Academy, the authority of the Administrator and the Board of Management of the Academy.
I/we agree that the Academy reserves the right, following admission, to discontinue enrollment if the Academy was misinformed or cannot meet the student’s individual needs.
I/we have read and understood the Rate Contributions and are jointly and severally liable.
I/we agree to pay all rates as detailed and understand non-payment excludes the student from attending.
I/we accept and be bound by health and medical rules for safety, and understand required medical evidence must be provided.
I/we agree the Academy acts "in loco parentis" and that teachers may discipline the student accordingly.
I/we agree the Academy may suspend or terminate enrollment for failure to comply with this Agreement or Academy rules.
I/we agree the Academy is not liable for loss or damage to the student’s belongings.
I/we allow the child to participate in all Academy activities including excursions.
I/we allow the Academy to give medical attention/treatment in emergencies.
I/we agree to have our contact details published in the directory unless notified otherwise.
I/we agree student photographs and recordings may be used for Academy marketing.
I/we indemnify the Academy and related parties against liability and will obtain insurance for the child.

Signature of Parent/Guardian: Signature of Parent/Guardian (if applicable): Date: