Request Information

Thank you for your interest in our school!

Use this form to schedule a tour of Horizon Academy. After this form is completed, a member of the admissions team will call you to schedule an exact date that will work best for both of you.

We recommend every prospective parent begins with a tour to get a feel for the school before a child is screened and considered for admission.

* Indicates a required field.

Parent/Guardian Information
*First Parent/Guardian
Salutation *

First Name *

Middle Name

Last Name *
Email Address *

Gender

Male Female
Second Parent/Guardian
Salutation

First Name

Middle Name

Last Name
Email Address

Gender

Male Female
Street Address *
City *
Country *
State *
Zip *

Would you prefer to be contacted by email or phone? *

	Email
	Phone
	Either is fine

What is the best number to reach you? *

How did you hear about Horizon Academy? *

	Internet		Doctor Referral
	Horizon Academy Board Member		Current/Former Parent
	Alumni		Staff
	Flyer/Handout		Community Organization
	Social Media		Other

Referred by whom? Specifically.
Student 1
First Name *

Middle Name

Last Name *
Birthdate *

(mm/dd/yyyy)

Email Address

Gender *

Male Female
Grade Level of Interest *

School Year *
Current School
Applicant has been diagnosed with the following learning differences: (Check all that apply) *

ADHD inattentive type ADHD Dyslexia Speech-Language Delay Auditory Processing Disorder Receptive/Expressive Language Articulation Disorder Fine Motor Delay Gross Motor Delay School Anxiety Other Testing in progress; diagnosis pending My child does not have a diagnosis
If "Other" checked above, please specify your child's diagnosis
What are your child's learning challenges? *
Is There Another Student? Yes No
Parent/Guardian Notes