Remote Learning

Basic Information

Name of child*

First Last

Child's preferred name*

Date of Birth*

Current age*

Current grade*

Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Present school*

Grade applying for:*

Parent/Guardian Contact Information

Parent/Guardian #1 name*

First Last

Additional Household

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preffered Phone*

Email*

Additional Parent/Guardian

Parent/Guardian #2 name

First Last

Same as student

Yes
No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred phone

Email

Additional Information

Please list all siblings Name, Age, and Present School (one per line)*

Please list Names and Your Relationship with any relatives or friends that attend or previously attended The Phoenix School

How did you learn about The Phoenix School?*

Describe your interest in The Phoenix School remote learning and why you are seeking this for your child.*

Are you interested in full time, part time, or something else?*

Full Time - 8:00am-3:00pm
Part Time - 8:00am-11:30pm
Other - Please Explain

Please explain what other options you would like for The Phoenix School Remote Learning.

Please describe your child’s personality and learning style.*

What do you see as your child’s particular strengths, talents, and challenges?*

Please list your child’s special interests (music, art, sports, drama, dance, computers, etc).

Has your child received any support services or therapy for any facet of his or her development?*

Yes
No

Please explain:

Please share with us any thoughts or concerns about your child that might further our understanding them.*

The Phoenix School Remote Learning Survey

Basic Information

Parent/Guardian Contact Information

Additional Parent/Guardian

Additional Information

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