Parent/Legal Guardian Information

Parent 1 First Name (Primary Contact) *

Parent 1 Last Name *

Parent 1 Phone *

Parent 1 Email *

Relationship to Child. *

Parent 2 First Name

Parent 2 Last Name

Parent 2 Phone

Parent 2 Email

Relationship to Child

Children Information

How Many Children are you auditioning for?

Child 1 First Name *

Child 1 Last Name *

Child 1 Date of Birth *

Child 1 Current Grade *

Child 1 Gender *

Please share if child 1 requires any special accommodations, IEP, 504, or behavior/learning plan. *

Please share if child 1 has any allergies or medical conditions we should be aware of *

Child 2 First Name *

Child 2 Last Name *

Child 2 Date of Birth *

Child 2 Current Grade *

Child 2 Gender *

Please share if child 2 requires any special accommodations, IEP, 504, or behavior/learning plan. *

Please share if child 2 has any allergies or medical conditions we should be aware of. *

Child 3 First Name *

Child 3 Last Name *

Child 3 Date of Birth *

Child 3 Current Grade *

Child 3 Gender *

Please share if child 3 requires any special accommodations, IEP, 504, or behavior/learning plan. *

Please share if child 3 has any allergies or medical conditions we should be aware of. (copy) *

Child 4 First Name *

Child 4 Last Name *

Child 4 Date of Birth *

Child 4 Current Grade *

Child 4 Gender *

Please share if child 4 requires any special accommodations, IEP, 504, or behavior/learning plan. *

Please share if child 4 has any allergies or medical conditions we should be aware of. *

General Information

When is your ideal start date?

Which Location Are You Auditioning For? *

Why have you chosen Acton Leadership Academy? What about our vision, mission, values, or learning design most aligns with your family culture? *

Please share any information you would like us to know about your child or family.

How did you first Learn about Acton Leadership Academy? *

Release Of Liability *

By signing, I fully release Acton Leadership Academy, Brad and/or Michelle Bowen, and all other employees or connected parties from any liability or recourse upon injury or harm to myself, my spouse, my child, or property. Additionally, I grant Acton Leadership Academy and associated parties the right to use any photos or videos obtained from participation in this event in their media and/or advertising.

I acknowledge that learning or behavioral needs must be disclosed during admissions, and documentation must be uploaded with my Audition forms. I understand the school is not equipped to meet the needs of students requiring intensive behavioral, therapeutic, or one-to-one academic support. The program is designed for students functioning within a typical range of ability and independence. If significant challenges arise after enrollment, I understand that the school will meet with my family to determine school fit and if my child would be better supported in a different environment designed to meet their needs.

Parent by signing below you agree to above waivers and verify you have not omitted any important medical information. *

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