ELIvation Schools Enrollment
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Email *
How did you hear about ELIvation Schools? *
Student's Full Name *
Student's Date of Birth *
Student Gender Identity *
Pronouns Student Prefers *
Student's Street Address *
Student's City *
Student State *
Student Zip Code *
Student's Phone Number *
Parent/Guardian 1 Name *
Parent/Guardian 1 Cell Phone Number *
Parent/Guardian 1 Email *
Parent/Guardian 1 Street Address *
Parent/Guardian 1 City *
Parent/Guardian 1 State *
Parent/Guardian 1 Zip Code *
Parent/Guardian 2 Name
Parent/Guardian 2 Cell Phone Number
Parent/Guardian 2 Email
Parent/Guardian 2 Street Address
Parent/Guardian 2 City
Parent/Guardian 2 State
Parent/Guardian 2 Zip Code
Student's Current School *
Student's Current Grade Level (2025-2026 School Year) *
Please list all confirmed diagnosis's your child has (please say "none" if there are none) *
Please list all suspected diagnosis's you or others suspect your child may have (please say "none" if there are none) *
Please list your student's strengths, favorites, joys, interests, activities *
Please list any other professionals and their contact information that your child is seeing *
What do you hope ELIvation Schools will accomplish with your child? *
What else do you want us to know about your child? *
I understand that I am disclosing private, confidential information about my child to ELIvation Schools and give my permission to ELIvation Schools to share this with employees, agents and contractors who will serve my student as needed to provide comprehensive history, background and care.  I understand I can revoke this permission at any time by sending an email to info@elivationschools.com. *
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A copy of your responses will be emailed to the address you provided.
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