Parent 1 Name
Parent 1 Phone Number
Address
Email Address
Parent 2 Name
Parent 2 Phone Number
Parent 2 Email Address
Are both parents living in the same household?
Child's Name
Child's Age
Child's Birthdate
Physician Name and Phone Number
Are there any special health considerations- allergies, dietary, medications, injuries?
List three emergency contacts with name, phone number, and relationship
Are you currently homeschooling? Have you homeschooled before? If not, what are your biggest concerns with choosing homeschooling?
Where has your child previously attended school or homeschool classes? Did they have any challenges academically, emotionally, or socially? If so, please describe.
Are you interested in full time (5 days a week), part time or just one or two class participation in Visionary Village offerings? Are you interested in our academic classes, enrichment classes, or both?
Does your child have any special needs, learning differences, or diagnosed/undiagnosed emotional or cognitive challenges? If so, please explain.
Please share any special considerations regarding your child’s emotional/social/cognitive/developmental needs?
Share your insights about your child's ability to understand spoken and written directions, and their abilitity to focus and complete tasks.
What are your goals and wishes for your child in participating in Visionary Village offerings?
Does your child have any special interests, skills, or creative talents?
Describe your family's relationship with technology- TV, gaming, social media, internet, etc. How frequently does your child use a gaming device, smart phone, computer, tablet?
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