Application

Clear Form

Session*

Program*

Child

Child's Name

Address

Birthday

Child's Gender

Social Security Number

Special NeedsDoes your child have any special needs (educational, medical, or psychological)? Has your child received any testing or evaluations that would relate to their academic or social performance? Please have copies sent of tests or evaluations that your child has taken.

Allergies

Does the student take any medications?If so, please list the name, dosage and time given.

Previous SchoolsPlease list every school that your child has attended

Why would you like your child to attend Hillsboro?

Is there additional information the school should know in order to best understand your child?

Will the student be enrolling in early/after care?

Yes

If so, which days?

Parent Information

Mother's Name

Father's Name

AddressAddress if different from above

Mother's Phone Number

Father's Phone Number

Mother's Email

Father's Email

Employer/Occupation

Mother's Occupation	Father's Occupation

Spouses

Full name of Mother's Spouse (if different from Father)	Full name of Father's Spouse (if different from Mother)

Please specify any custody arrangements.

Siblings

If Legal Guardian is someone other than parent, please fill out.

Full Name of Legal Guardian	Legal Guardian Phone Number	Legal Guardian Address	Legal Guardian Employer/Occupation

Health Insurance

Insurance Company

Insurance Number/ Group Number

Name of Insured

Employer

Approved Pickup List

Approved Adults

Name	Phone Number	Relationship

Emergency Contacts

Name	Phone	Email

Student's Pediatrician

Name	Phone

Medical Conditions

How did you hear about us?

Non-Discrimination Policy

We value diversity among our students. We do not discriminate in our enrollment policies on the basis of race, color, gender, religion, sexual orientation, national or ethnic origin.

To complete the application, school records should be emailed to admissions@thehillsboroschool.org or sent directly by your child’s current school to:

The Hillsboro School
73 Elvira Road
Helena, AL 35080

A $100 application fee is due with submission of the application. Payment can be made through our website under “Tuition and Fees”.

Upon application acceptance, the following is required prior to the first day of school:

copy of a photo id for everyone on approved pickup list

copy of insurance card

copy of the State of Alabama Certificate of Immunization

signature pages for contract, handbook and policies

$500 deposit