Evergreen Academy Pre-Registration Form for 25-26 school year

For families with multiple children, please fill out one form per child, thank you!

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Name of student

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What is your child's birthday?

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What is your child's gender?

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What is your child's primary ethnic background?

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Does your child have any medically indicated conditions?

Food allergies, medical diagnoses of any kind

YesNo

If yes, please describe

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Is your child currently enrolled in any school, homeschool co-op or any other type of academic program?

YesNo

If yes, please describe

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Has your child previously been enrolled in any school, homeschool co-op, or academic program outside the home?

YesNo

If yes, please describe

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Has your child ever been asked to leave a school, daycare, co op, or any other type of learning environment outside the home?

YesNo

If answered yes, please explain.

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Does your child currently receive services such as OT, PT, ST, Behavioral, or Psychotherapy?

YesNoNot currently, but has in the past

If yes, please describe

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What programming are you interested in enrolling your child in at Evergreen Academy?

Check all that apply

Full time (4 day) option Monday-ThursdayPart time (2 day) option Monday/Wednesday or Tuesday/ThursdayAfter school tutoringHomeschool enrichment day I am interested for the 26-27 school yearSummer camps

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When considering an alternative learning environment for your child, what are your top priorities?

Choose 2

Core academicsSocial emotional learningNature based play and learning Unstructured play with peers outside Enrichment opportunities (art, music, STEM, cooking, gardening)Field trip and community outing opportunities Physical activity

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Does your child currently receive educational vouchers?

YesNo

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If the answer is no, do you plan on applying to receive educational vouchers?

YesNoNot sure

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Do you plan on using vouchers to apply towards our tuition?

YesNoI want more information about tuition assistance

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We are located in Conway, AR. How far of a commute is our school from your primary place of residence?

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We offer a secular, alternative learning environment for children aged 5-9. Our students have access to green and garden spaces on our urban farm setting. Do you have any concerns at all about your child being successful and safe in this environment?

YesNoNot sure

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If yes or not sure, please explain.

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Parents and caregivers are valued in our nature based microschool. How do you envision contributing to our school community?

No contribution is too small! Check all that apply.

Sharing a special skill or knowledgePlanning field trips or community outingsSubbing if needed Contributing resources that help our school run effectively Fundraising Planning special events for our school community (parties, pot lucks, etc.) Planning and implementing social justice and community outreach activities (making blessing bags, food pantry collection, etc.)

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We would love to hear more about why you are interested in Evergreen Academy for your child.

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How did you hear about Evergreen Academy?

Social mediaA friend or family memberWebsite Advertising at a local business Other:

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What is your phone number and email address?

This information will remain confidential and we will only reach out for school related purposes.

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I am interested in coming to an open house or meeting staff in person.

YesNoOther:

Please email: info@evergreenacademy.co.site with any questions or for more information.

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I understand that completing this form does not officially enroll my child in Evergreen Academy.

Evergreen Academy (previously known as The Farm School) is undergoing new ownership. We ask that you please bear with us during this transitional time. If your child's application is considered for enrollment in our program, we will reach out as soon as possible. Thank you so much for your interest in our school and for taking the time to fill this out!

I understand.

Full name

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