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Enrollment Application

  • Please select all Programs that you are interested in:
  • Please select all Specials that you are interested in:
  • Child's Information

  • MM slash DD slash YYYY
  • Parent/Guardian 1 Information

  • Parent/Guardian 2 Information

  • Emergency Contact 1

    Each child is required to have an additional two emergency contacts, other than the 2 parents/guardians. Child will be released only to the parents/guardians listed above. If we are unable to contact the above, the child can also be released to the following individuals, as authorized by the person who signs this application. In the event of an emergency, if the parents/guardians cannot be reached, the facility has permission to contact the following individuals:
  • Emergency Contact 2

    Each child is required to have an additional two emergency contacts, other than the 2 parents/guardians. Child will be released only to the parents/guardians listed above. If we are unable to contact the above, the child can also be released to the following individuals, as authorized by the person who signs this application. In the event of an emergency, if the parents/guardians cannot be reached, the facility has permission to contact the following individuals:
  • The below information helps us to understand the family dynamics.

  • Medical Information

    Please be honest and as detailed as possible. For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be submitted. The medical action plan must be completed by the child's parent or healthcare professional. Please submit the Medical Action Plan (if needed) via email to (The Medical Action Plan must be updated on an annual basis and when changes occur to the plan).
    Independence Academy Agrees (updated as of 05/01/2024)
  • All About Me

    Child Developmental Insights: We believe that you are your child's first and most important teacher. We believe that education is a partnership between home and childcare/school. To begin this communication, please take some time to tell us a little about your child.
  • Application Fee

    There is a $75.00 non-refundable application fee.
  • Inde Elementary & Inde Hangout

    If you interested in the Inde Elementary or Home School Hangout program, please fill out the below section. If you are not interested in this program, please skip this section by scrolling to the bottom, and submit the application.