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.

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Parent / Guardian Information
First Parent / Guardian Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female	Second Parent / Guardian (leave blank if not applicable) Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female

Home Address
Street Address * City * Country * State * Zip * What program are you interested in at Horizon Academy? * School Year Tutoring Center (School Year) Tutoring Center (Summer) Summer School 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