Student First Name *

Student Last Name *

Date of birth *

Grade *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email *

Phone *

City *

State *

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What type of education does your child participate right now? *

Referral Source

What interests you the most about Elite Performance Prep Academy? *

The following questions help us gain a better understanding to best serve you and your family.

Has your child been homeschooled before? *

How serious are you about homeschooling your child(ren)? *

What major concerns do you have right now with your child's current education?

Does your child participate in any extracurricular activities? *

If so, what type?

Is there additional information we should know about your family and children before scheduling a call? *