SunGate Educational Program Admissions Form

Step 1 of 13

Child's primary information

Child's full name*

Include Nicknames

Child's DOB*

Month

Day

Year

Place of birth

Gender

Height

Weight

Hair color

Eye color

Recent photo of your child

The title of the file should be your child’s full name

Accepted file types: jpg, jpeg, gif, png, Max. file size: 256 MB.

How would you describe your child? Please provide a short description

Educational History

Describe your child's current and past educational programming.

What are your child's learning strengths and needs?

What learning goals are important to you as a family?

Please share any other information about your child's learning that would be important for us to know.

Biological parent's primary information

Duplicate mailings

Yes. Send duplicate mailings to separate households

Biological mother's full name*

Include Nicknames

Bio mother's DOB

Month

Day

Year

Email*

Enter Email Confirm Email

Bio mother's age at child's birth

Preferred phone number*

Occupation

Business name/address

Address

Street Address City State ZIP Code

Please select all which apply

Married

Separated

Single

Divorced

Widowed

Remarried

Biological father's full name*

Include Nicknames

Bio father's DOB

Month

Day

Year

Email*

Enter Email Confirm Email

Bio father's age at child's birth

Preferred phone number*

Occupation

Business name/address

Address

Street Address City State ZIP Code

Please select all which apply

Married

Separated

Single

Divorced

Widowed

Remarried

Custodial parent's primary information

Check if same

Custodial mother is the same as biological mother

Custodial mother's full name

Include Nicknames

Custodial mother's DOB

Month

Day

Year

Address

Street Address City State ZIP Code

Enter Email Confirm Email

Occupation

Business name / address

Preferred phone number

Check if same

Custodial father is the same as biological father

Custodial father's full name

Include Nicknames

Custodial father's DOB

Month

Day

Year

Address

Street Address City State ZIP Code

Enter Email Confirm Email

Occupation

Business name/address

Preferred phone number

Additional family information

Emergency contact information

These two emergency contacts will be called in the event we cannot reach the mother or father.

Contact #1 full name*

Include Nicknames

Contact #1 relationship*

Include Nicknames

Contact #1 phone number*

Contact #2 full name*

Include Nicknames

Contact #2 relationship*

Include Nicknames

Contact #2 phone number*

Home Life

Sibling Name #1

Include Nicknames

Sibling #1 DOB

Month

Day

Year

Sibling Name #2

Include Nicknames

Sibling #2 DOB

Month

Day

Year

Sibling Name #3

Include Nicknames

Sibling #3 DOB

Month

Day

Year

Sibling Name #4

Include Nicknames

Sibling #4 DOB

Month

Day

Year

Describe your child's relationship to sibling(s)

Describe home life values/attitudes you consider important*

Primary language spoken at home*

Does your family celebrate festivals?

Yes

Please indicate how often your child use a computer.

Please indicate how often your child plays video games.

Please indicate how often your child watches TV.

Which programs?

How often does your child listen to audiobooks, radio or recorded music

Are you willing to modify your child's media engagement in order to facilitate their learning in the enrichment program?

Yes

Describe your child's indoor and outdoor play environment

Describe how you discipline your child

Self-care

Describe your child's ability to manage self-care (toileting, dressing etc)

Sleeping Habits

Describe your child's sleeping habits (bedtime, how long, how deeply)

How does your child awaken (dreamy, cheerful)?

Does your child wet the bed?

Yes

Under what circumstances does your child wet the bed?

Does your child take a daily nap?

Yes

How long does your child rest during the day?

Does your child fall asleep easily?

Yes

Does your child have a history of recurring nightmares?

Yes

Eating habits

Describe what your child eats for breakfast, lunch, dinner and snacks.

Yes, my child enjoys eating.

Yes, my child follows a special diet.

Does your child have food allergies or sensitivities?

Yes

List allergies or sensitivities to foods.

What food(s) does your child like the most?

What food(s) does your child like the least?

Medical information

List all current medications and purposes (seizures, anxiety, behavior, etc.) dosages, and when started (approximately)

Current medications

My child is currently NOT taking any medications

Medication #1

Dosage #1

Purpose #1

Date Started Medication #1

Month

Day

Year

Medication #2

Dosage #2

Purpose #2

Date Started Medication #2

Month

Day

Year

Medication #3

Dosage #3

Purpose #3

Date Started Medication #3

Month

Day

Year

Medication #4

Dosage #4

Purpose #4

Date Started Medication #4

Month

Day

Year

Medication #5

Dosage #5

Purpose #5

Date Started Medication #5

Month

Day

Year

Medication #6

Dosage #6

Purpose #6

Date Started Medication #6

Month

Day

Year

If you need to add more medications, please add them here.

List any immunizations your child has received

Describe any reactions to immunizations

List the illnesses or childhood diseases your child has had and at what ages

Describe known allergies

List medical insurance information (primary doctor, insurance provider, etc)

List any other health information you would like us to know

Additional information

List any other general information you would like us to know or did not have room to fill out completely

How did you learn about Sungate?

Friend

Posted flyer

Google/internet search

A currently enrolled family

A formerly enrolled family

Other

Describe the "other" way you learned about Sungate

Describe briefly why you are interested in Sungate for your child.

Parent participation

Sungate is a cooperative program, and parents have the opportunity to contribute both through monetary gifts and volunteer work. We also understand that there are households in which both parents work full time and that it is often not possible to be physically present at the program. All contributions big and small are valued.

As with all Homeschool Cooperatives, active parent involvement is expected. This includes participation in school events, parent conferences and workshops, as well as a general willingness to try and create consistency and continuity between home and our program. We require all parents to attend one workshop or conference per month.

Assisting with the program during the day.

I would be available to help with (check all that apply):

Set up or clean up

Looking after children during recess

Cooking at Sungate

Helping children with handwork

Hiking with a group of children and adult

Supporting children during a teacher led activity

Gardening

Other

Describe "other" activity you would be able to help with

I would be able to assist with the program at home in these ways (check all that apply):

Helping with laundry

Sending in a meal

Sewing

Helping with an occasional project on a weekend day

Coordinating communication and emails

Help with fundraising

Photocopies, laminating and other office type tasks

Ordering supplies

Other

Describe "other" way you would be able to assist the program from home

Signatures

By Typing parent's name here, the child's parent is in effect signing this form*

Date signed*

Month

Day

Year

By Typing other parent's name here, the other parent of the child is in effect signing this form

Date signed

Month

Day

Year

Consent*

I agree that the person(s) completing this form is/are legally able to make decisions regarding this child’s schooling.

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

SunGate Educational Program Admissions Application

Child's primary information

Educational History

Biological parent's primary information

Custodial parent's primary information

Emergency contact information

Home Life

Self-care

Sleeping Habits

Eating habits

Medical information

Additional information

Parent participation

Signatures

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