Education and Home Support Assessment Form
This form is should be completed only after an application has been submitted and you have received a letter of attendance. Please complete all required questions as they are important in our learning about your child and family's needs and interests. (Required questions have an asterisk beside them). For students enrolling in our half and full day programs, please provide any supporting IEP, Diagnoses or other needed documentation, at your educational and home study. Your Home Study will be chosen from dates and times you will list on this form. Families enrolling their child in a single class, will not need to complete the home assessment.

This assessment includes on-going educational and behavioral reviews, as needed, to address your child's educational, developmental, and behavioral needs, both at home and on campus. This meeting can be held on campus or at your home, with parents and student(s), to discuss student and parent goals, and review any previous documentation, all to help design a formal goal and progress oriented individual educational plan (and behavioral plan if needed) for your child. This plan will be in place for the time your child is enrolled at HopeWell, for teachers and assistants to use in best meeting your child's needs. A copy of this IEP and any BIP, will be provided to you before or at the parent orientation meeting to be held in August.

To complete half or full day enrollment for your child, the last month's tuition fees should be provided during the Educational and Home Assessment to guarantee enrollment.

Please note, all information provided on this questionaire is secured and confidentially held. It will not be shared with other staff members or any other individuals associated with HopeWell Classical Day School. The initial and final IEP and BIP will be shared with staff for training and information to help them best meet the needs of your child.

Email address *
Student's Name *
Your answer
Student's Date of Birth *
Your answer
Current Grade *
Your answer
Father's Name *
Your answer
Father's cell phone *
Your answer
Mother's Name *
Your answer
Mother's Cell phone *
Your answer
Length of time homeschooled *
Your answer
What led your family to homeschool? *
Your answer
What would you like most for us to know about your child? *
Your answer
When were you first aware you child had unique needs? What were they? *
Your answer
What goals, hopes or intentions do you have for your child this year *
Your answer
What are your child's natural talents and gifts? Are they aware and proud of these?
Your answer
What would you say is your child's greatest challenge? *
Your answer
What specific dates and times within the next 30 days would you like to schedule your family's home and educational study *
Your answer
If you have further questions you would like us to address, please list here
Your answer
HopeWell Classical Day School Release Form I Release, Discharge, Waiver and Hold Harmless AgreementMedical Attention *I hereby authorize any staff member and/or adult sponsor who may be supervising or directing any activity sponsored by HopeWell, to authorize medical treatment, including but not limited to emergency surgery. I agree to assume liability for any and all costs and expenses incurred, including medical and dental costs, and that HopeWell Classical Day School, its board members, and parent volunteers with them are not responsible. This agreement also applies to all companies and all staff members associated with field trips. (By typing your full name in the space below, you agree to this statement.) *
Your answer
Liability Release *I understand that the risk of injury from any recreational and work activity is possible, including, but not limited to, the potential for permanent paralysis and death. While my child's BIP and IEP, particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I knowingly and freely assume all risks, both known and unknown, even if arising from negligence, and assume full responsibility for my child's participation and observing of such recreational and work activities. I do hereby release, forever discharge, and covenant to hold harmless HopeWell Classical Day School, its board members, and parent volunteers, and its staff, from any and all liability, claims or demands for personal injury, sickness and death, as well as property damage and expenses, of any nature whatsoever while participating in any event sponsored by HopeWell Classical Day School. This agreement also applies to any and all activities on or off HopeWell's campus. (By typing your full name in the space below, you agree to this statement.) *
Your answer
Media Release. I hereby grant permission for HopeWell Classical Day School to publish pictures containing images, but not names, of my children on the HopeWellDay.org website and in HopeWell documents to promote the functions of this school. I understand these images will be available in the public domain through the internet. Names and other identifiers will NOT be used to identify people in any published pictures. *
Permission to Participate *I hereby grant permission for my child to participate fully in any and all events and/or activities that are a part of any program or activity on campus for HopeWell Classical Day School. (By typing your full name in the space below, you agree to this statement.) *
Your answer
In listing our name below, I agree to keep our scheduled appointment once scheduled to the best of my ability and provide payment for the $150 initial assessment fee at the time of the assessment. *
Your answer
A copy of your responses will be emailed to the address you provided.
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