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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.

Before you proceed with enrollment, read these blog posts:
A Parent’s Guide to Apollo Academy: What to Expect from Our Learner-Driven Community.
The Parent’s Hero’s Journey: Embracing the Uncomfortable Path at Apollo Academy.
The Reward of the Journey: What Happens When Parents Lean In.

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 Nicholle@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)
StepUp Scholarship Status*
- I've been awarded
- I'm in the process of being awarded
- We are not applying
- I am not sure but would like more info on Step Ups
StepUp Scholarship Award ID(s). This is different from student ID. Please refer to the acceptance letter PDF you received via email from StepUps.
Step Ups Scholarship Amount (list each learner)

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.
Please upload proof of medical insurance.*
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):*
- Honor Code
- Illness Policy
- Emergency Procedures
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
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*

Application Process
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Basic Information

Medical Information & Authorization

Acknowledgement of Policies