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Apollo Academy Enrollment Form

We are so excited that you’re family is joining us! It’s finally time to officially enroll at Apollo Academy.

The following enrollment form has three sections: basic information, medical history and authorizations/acknowledgements. Prior to completing the enrollment form, please thoroughly read the Family Playbook.

Plan to set aside about 15 minutes to complete this form. To make the process a little easier, please have an electronic copy of the following documents ready to upload: birth certificate and recent immunization records.

If you have any questions about the Family Playbook or enrollment form, please email BethAnn@theApolloAcademy.com.

The name and photo associated with your Google account will be recorded when you upload files and submit this form.

Step 1 of 3

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Basic Information
Child's Full Name*
Child Prefers To Be Called*
Child's Primary Address*
Child's Date of Birth*
Primary Caregiver #1 First Name*
Primary Caregiver #1 Last Name*
Primary Caregiver #1 Phone Number*
Primary Caregiver #1 Email Address*
Enter Email Confirm Email
Primary Caregiver #2 First Name
Primary Caregiver #2 Last Name
Primary Caregiver #2 Phone Number
Primary Caregiver #2 Email Address
Enter Email Confirm Email
Emergency Contact First Name (In addition to caregivers)*
Emergency Contact Last Name (In addition to caregivers)*
Emergency Contact Phone Number*
Emergency Contact Email Address*
Enter Email Confirm Email
Would you like to add your contact info to the Apollo Families Contact List that will be circulated this summer?*
- Yes
- No (& I understand my choice to not participate means that I will not receive the contact list)

Medical Information & Authorization
Any adverse reactions to medications?*
If so, detail in section below.
Is child currently taking any medications?*
If yes, note the type/dosage below.
Any allergies to food or environment?*
If so, detail in section below.
Any dietary restrictions?*
If so, detail in section below.
Any respiratory problems or asthma?*
If so, detail in section below.
Has child been stung by a bee?*
If so, detail in section below.
Any heart defects or heart disease?*
If so, detail in section below.
Any history of seizures or epilepsy?*
If so, detail in section below.
Any ankle/knee/hip or joint problems?*
If so, detail in section below.
Has child been under the care of a mental health care professional?*
If so, detail in section below.
Does student have any medical conditions that may preclude strenuous activities?*
If so, detail in section below.
Does child wear glasses or contacts?*
If so, detail in section below.
Has child been diagnosed with hearing loss?*
If so, detail in section below.
Does your child have a conscientious or medical exemption for immunizations?*
If you answered "Yes" to any of the above, please add detail here. If not, type N/A.*
Please LIST & DATE significant medical history including hernias, ulcers, head injuries, cancer, arthritis, scoliosis, hearing/vision problems, learning differences, eating disorders or other illnesses. Also note accommodations, and any pre-existing medical conditions.*
In the event of a medical emergency, I authorize Apollo Academy staff, contractors or medical personnel to obtain or provide emergency medical care for my child, to transport my child to a medical facility and to secure treatment they consider necessary for my child’s health.*
- Yes
- No
I agree to pay all costs associated with that care and transportation and agree to release any medical records necessary for treatment, referral, billing or insurance purposes.*
- Yes
- No
Except to the extent limited by this form, my child has permission to participate in all Apollo Academy activities. I authorize that all information on this form is accurate and complete and I have not withheld any information.*
- Yes
- No
Please upload the most recent immunization records.
Drop files here or

Max. file size: 32 MB.
Please upload a copy of your child's birth certificate.
Drop files here or

Max. file size: 32 MB.

Acknowledgement of Policies
All caregivers have read the Family Playbook and agree to uphold the standards and policies outlined within.*
- Yes
- No
All caregivers have read the Family Playbook and understand how Apollo Academy is very different from traditional school and are in support of a learner-driven approach.*
- Yes
- No
This includes my agreement to uphold the following FAMILY standards and policies (please check all boxes):*
- Dress Code Policy
- Honor Code
- Illness Policy
- Emergency Procedures
- Birthday Celebrations
This includes my agreement to uphold the following TECHNOLOGY standards and policies (please check all boxes):*
- Apollo Academy Property
- Internet Safety
- Social Media Policy
- Personal Technology Brought Into Studio
- Electronic Policies
This includes my agreement to uphold the following PARENT standards and policies (please check all boxes):*
- Carpool Times and Procedures
- Parent Conduct
- Parent Meetings
- Contacting a Guide
- Studio Observation
I have reviewed the contracts in the Family Playbook and feel comfortable signing the parent contract in the first session of the school year.*
- Yes
- No
I understand that there will be no fieldtrips in the first semester. Any fieldtrip will be voted on by our families and with a majority vote we will proceed with the fieldtrip. I understand that fieldtrips may cost extra in addition to tuition, but all details will be communicated at least one month in advance.*
- Yes
- No
We are in the process of establishing out After School Program that will extend our school day from 3:00 to 5:30. What statement best describes your family?*
- Our family will rely on these extended hours for childcare.
- If my child is interested in the program for a particular session, then I will allow my child to participate in that session, but we do not need afterschool care.
- We will likely not use any after school program
I consent to my child(ren), myself and other caregivers being photographed or videotaped for use by Apollo Academy. I recognize that media will be used at the discretion of Apollo Academy, but only to further share the vision and mission, and not for other personal or commercial gain. I also recognize that Apollo Academy is committed to the safety and well-being of my child(ren) as their first priority. Examples of media use are: weekly blog for parents and families about events, media about the school for interested families, social media posts.*
- I consent
- I do NOT consent
Consent*
I certify that the information provided is accurate.
Type your name for signature*
Date*

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