Name *

First Name

Last Name

Special Education Services

Are there any special education services (IEP, 504 Plan, etc.) provided to your student?

Yes

No

Counseling

I am interested in my student receiving counseling through Freedom.

Yes

No

Parent/Guardian Permission

By checking this box, I am committed to my student attending Freedom consistently or their spot may be given to a student on the waitlist.

Parent or Guardian Name *

First Name

Last Name

Parent or Guardian Phone *

(###)

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