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 *
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