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Thank you for your interest in Horizon Academy!

Use this form to start the process to learn more about our programming and resources. After this form is completed, a member of either the Admissions staff or the Learning Center will follow-up with you to discuss the next step, based on your area of your interest.

Please add me to your contacts so as to not delay your receipt of follow-up communication by email.

My email address is lmombello@horizon-academy.com.

Sincerely,

Laura Mombello
Admissions/Enrollment Manager and
Learning Center Coordinator
 

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Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone *

  • Is your interest in 1st - 12th grade programs or Kindergarten programs?
    *

  • How did you hear about Horizon Academy?
    *

  • Referred by whom? Specifically.
    *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
  • Grade Level of Interest *
    School Year *
  • Current School

  • What is your student's current grade level?
    *

  • What is your Student's Gender?
    *

  • What personal pronouns does your student use?
    *

  • Are you interested in Kindergarten programs or 1st - 12th grade programs?

  • My child has been diagnosed with ADHD:
    *

  • What are your child's learning challenges?
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •