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Homeschool Therapy Enrollment Form

Student Information:

Full Name

Date of Birth

Parent/Guardian Information:

Full Name

E-mail Address

Phone Number

Address (Include state, city, and zip)


Please attach/provide a copy of all reports and evaluations

Has your child been diagnosed with dyslexia by a clinical psychologist?

YesNoIs Scheduled


Date of Testing or Diagnosis

Clinical Evaluation and Diagnosis Results

Additional services/reports may include: Tutoring, Counseling, Speech/Language Therapy, Occupationsl Therapy, etc.

What services have been recommended for your child?
TutoringCounselingSpeech/Language TherapyOccupational TherapyMedication

Any Schools Attended

Current Grade Level

Who referred you to BBA?

State your primary concern.

What factors do you think might have contributed to the difficulty?

Does your child feel he/she has a problem? (If so, describe these feelings.)

Student Hobbies, Interests, Talents or Abilities


Terms And Conditions:

a. Applications are made to the governing authority of Bright Beginnings Academy which reserves the right to accept or reject any application.
b. Bright Beginnings Academy admits students of any race, color, or national and ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students of the school. Bright Beginnings does not discriminate on the basis of race, color, or national and ethnic origin in administration of its educational policies.
c. School policies are subject to change. Information on current policies will be made available at parent orientation meetings prior to enrollment.
d. Applicants agree to abide by all school policies, rules and regulations, including provisions for dress codes and discipline.
e. Applicants agree that their students will receive instruction in the Christian Faith and understand that the school will endeavor to be guided by a Christian worldview in all of its programs and activities.
f. The school has policies designed to meet a reasonable standard of care for students who become ill or have an emergency situation at school. Parents are required to sign a medical release form each year allowing emergency medical care to be obtained in the case parents cannot be reached. Parents understand the school is not an insurer of student health. The school procedures governing health care plans and the storage and administration of medications are available from the Admissions Director.
g. The school’s Schedule of Charges provides information about financial terms and obligations. It is updated annually. Students are enrolled for the entire year and the parent or guardian is responsible for the annual tuition payment upon accepting enrollment.
I hereby certify that I have read this Student Application Form, including the Terms and Conditions Section. I do agree to comply with the terms and conditions stated therein and furthermore accept the conditions and requirements of all other official policies and procedures of Bright Beginnings, including the payment of all fees and charges according to the published schedule of the school. This application cannot be processed until the application fee is paid in full and the application is signed by the parents or guardian of the applicant.

I agree to these terms

The information provided on this application is correct and complete to the best of my knowledge.

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