To apply to The Birches Academy of Academics & Art for the academic year 2022-2023 please complete this application. Applications for Kindergarten must be received no later than Midnight on Monday, January 31, 2022 to be considered for the Kindergarten lottery. If you have any questions please contact us at information@birchesacademy.org.

Student Information:

Does student have a sibling currently enrolled at the Birches Academy? *

Yes

No

Student Date of Birth (MM/DD/YY) *

Grade Student will be entering in September 2022 *

K	1	2	3	4	5	6	7
8

Male

Female

*

Age as of 9/30/2022: *

City, State and Country of Birth *

If born outside the USA, please provide the date first entered the USA school system.

Race
*

2 - Asian

3 - Hispanic

4 - Black

5 - White

Other Other

Student Name: First, Full Middle (Required), Last *

Legal Street Address: *

City/Town: *

Zip *

Primary language spoken at home *

Parent/Guardian Information:

Parent 1/Guardian Name: *

Relationship to Student: *

Address (if different from above):

Primary Phone Number: *

Alternate Phone Number:

E-mail address:

I give permission to The Birches Academy to send me updates via e-mail: *

yes

no

Primary Language *

Military Status *

None

Active Duty in Armed Forces (not including National Guard)

Full Time National Guard

Parent 2/Guardian Name:

Relationship to Student:

Address (if different from above):

Primary Phone Number:

Alternate Phone Number:

E-mail address:

I give permission to The Birches Academy to send me updates via e-mail:

yes

no

Primary Language

Military Status

None

Active Duty in Armed Forces (not including National Guard)

Full Time National Guard

How did you hear about us? *

If Other is chosen, please explain.

Schooling Information

Please list all schools (including Home Schooling) this student has attended.

Current School: *

Current Grade *

City/State *

Dates Attended: *

Previous School (if any):

City/State

Dates Attended:

Previous School (if any):

City/State

Dates Attended:

Sibling Information

Please list the names and entering grades for any sibling that will also be applying to The Birches Academy.
Please note all siblings must be entered on a separate Enrollment Form as well as listed here.

Sibling 1 Name

Sibling 1 entering grade in September 2022

Sibling 2 Name

Sibling 2 entering grade in September 2022

Sibling 3 Name

Sibling 3 entering grade in September 2022

Sibling 4 Name

Sibling 4 entering grade in September 2022

Declaration of Truth

1. I am submitting my child's name into The Birches Academy Admission Process.
2. I understand that submitting this application does not guarantee admission to The Birches Academy.
3. I understand that should my child be offered enrollment in The Birches Academy, I must provide a complete health form as required by the State of New Hampshire.
4. I understand that should my child be offered enrollment in The Birches Academy, I will be required to provide additional paperwork, such as transcripts and IEP documentation.

Parent/Guardian Name: *

Date *

Additional Information

New Hampshire’s Statutes and Rules require that a school district keep accurate records and

updated personal files for all pupils. This information will become part of the student's permanent

cumulative record and will be available to appropriate staff members or child’s parents. New

Hampshire law requires that you provide Immunization information to your child's school.

As an equal educational opportunity provider for all students, The Birches Academy, shall not discriminate on the basis of race, color, religion, national origin, creed, sex, mental or physical disability, special need, veteran status, sexual orientation, proficiency in the English langauage, prior academic achievement or marital status.

You will receive a confirmation e-mail upon the completion of this form, if you do not please contact us at information@birchesacademy.org.
Thank you for your interest.