Re-Enrollment Application Form
Please fill out this online re-enrollment form in order to renew your child’s enrollment for 2019-20 school year. The early bird deadline for re-enrollment is Friday, February 8, 2019. If HSA students have this application form filled out by the deadline, then their material fee of $25.00 will be completely free for the 2019-2020 school year. If you do not have the application form completed by that date, then your child’s placement will not be guaranteed and you will be charged the full material fee of $25.00.

If you are charged the material fee then please make sure we receive your payment, which could be made in cash, credit, money order, or personal check. All students that return the form by Friday, February 8, 2019 will also receive a sweet treat for grades K-5 or a dress down pass for grades 6-12.

**Also, if you have already sent in your printed re-enrollment form then there is no need to fill this information out.

Student Name *
(First and Last)
Parent/Guardian Name *
Upload a picture for your Proof of Residency (POR). Examples include a cable bill , gas bill, electric bill, water bill, pay stub, or lease. *
This is newly required by law (House Bill 21) as of September 2018. Picture needs to capture document that includes your full name, current date, address, and utility information.
City *
State *
Zip Code *
Home Phone *
Work Phone *
Cell Phone *
Email Address *
Relationship to Student *
Student Lives With: *
My child will return to Horizon Science Academy for the 2019-20. *
Grade my child will be entering in the 19-20 school year. *
(Ex: Child is now in first grade, so they will be going to second grade)
Student gender. *
My child will not return to Horizon Science Academy. (Provide Reason Below) *
Electronic Signature & Date Below *
(Ex: Jim Smithsonian 1-1-18)
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