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Enrollment Application for ASD Students
5 - 7 years old

Application

Child's Information:

First Name

MiddleName

Last Name

Age

Present Grade (If Applicable)

Birthday

Gender

Parent's Information:

First Name

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Cell Phone Number

Work Phone Number

Second Parent Information:

First Name

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Cell Phone Number

Work Phone Number

Health:

List any allergies your child may have:

List any medications your child is taking:

If your child has a special diet list it below:

List all foods your child is not allowed to have:

List any medical diagnosis your child may have:

If your child is taking any therapies please list them below:

Please explain any other important health information we should be aware of. For example: seizures, panic attacks, etc.

Educational History

How is the student currently enrolled?

Public School

Charter School

Private School

Homeschool

School student is currently enrolled at:

Has the student ever been evaluated for educational, learning, behavioral, or emotional reasons?

Has your child ever repeated a grade level? If so, what grade?

How will your child be attending classes?

In Person

Online

Hybrid: Online & In Person

How did you hear about Learning Cove Academy?

Friend

Online Search

Instagram

Facebook

Parent Organization

Therapist

Other

What kind of rewards does your child enjoy? (Ex: Play-doh, bubbles, squishy toys, bendy toys/sticks, foods, etc.)

What are some things your child struggles with or does not like? (Ex: Loud noises, group singing, getting wet or dirty, etc.)

FEES

Registration
There is a non-refundable registration fee to reserve a position for Learning Cove Academy. The registration fee will ensure the child's place at Learning Cove Academy. Students will not be enrolled in classes and a learning plan along with curriculum will not be selected until the registration fee is received. The registration fee is $250. Sign below to state that you understand and agree with these terms.

Your Signature

Materials
Our program is very interactive and hands on including cooking, weekly Science and STEM experiments, mixed media art projects and more. The materials fee will be used towards supplies for student projects. This is a one-time non-refundable fee of $300. All students must pay the materials fee before being enrolled. Sign below to state that you understand and agree.

Your Signature

Select the button below to make the payment for the registration and materials fee. A 3% processing fee has been added. You may send payments through Zelle to learningcoveacademy@gmail.com to avoid the processing fee.

Thanks for submitting!

Learning Cove Academy
3350 SW 144 Ave
Miami, Florida 33175
Phone: 786-321-5683 email: learningcoveacademy@gmail.com

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