Application Form - Wellspring Academy

PRIMARY CONTACT INFORMATION

First Name of Primary Contact

Last Name of Primary Contact

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Email Address

Primary Contact's Phone/Mobile

Relationship to Child

SECONDARY CONTACT INFORMATION

First Name of Secondary Contact

Last Name of Secondary Contact

Secondary Contact Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Contact's Email

Secondary Contact Phone Number

Relationship to Child

PARENT/GUARDIAN AND FAMILY INFORMATION

Please fill out the following information for both parents.

Marital Status - Father

Married

Widowed

Separated

Divorced

Remarried

Receives Bill - Father

Yes

Lives with Student - Father

Yes

Marital Status - Mother

Married

Widowed

Separated

Divorced

Remarried

Lives with Student - Mother

Yes

Receives Bill - Mother

Yes

If parents are separated or divorced, who has legal custody?

Mother

Father

In the event of sole primary custody, the school requires copies of the custodial legal documents to be provided at the time of application.

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STUDENT APPLICATION (please complete this application for each student)

Repeater Container

First Name

Grade

Last Name

Birth Date

First Name

Last Name

Birthdate: M/D/YEAR

Grade for 2025/2026 School Year

Kindergarten

1st

2nd

3rd

4th

5th

6th

7th

8th

Highschool

Tell us about your child's education/schooling. Describe the aspects of your child's previous educational experiences which aligned (or not) with your philosophy/desire for his/her education.

Please tell us about your child's temperament.

Tell us about your child's outdoor activity.

Are there any academic areas or behavior areas of concern? If so, please explain.

Does your child have any suspected or diagnosed learning differences, giftedness, or special needs? Please elaborate.

Does your child have any health issues? If so, please explain.

What, if any, medications is your child currently taking? Please include the reason for the medication.

Overall Questions

What is it about Wellspring Academy that appeal to you? Why do you think it will be a good choice for your child/ren?

Imagine that your child/ren are 18 years old and everthing in his/her development and education turned out as you hoped. Try to describe him/her as a young adult. What charactistics and values would he/she have developed?

We require reading "For The Children's Sake" by Susan Schaeffer Macaulay
(Let us know if you need this book on loan.) What other (if any) Charlotte Mason resources do you use/have you read? What are your thoughts on this approach to education and parenting?

For Children's Sake thoughts

Please view the recommended CMI Videos 1-11
What are your thoughts on these/what captured your interest?

CMI Video Thoughts

Do you regularly attend church or other faith-based organization? And if so, for how long and which one?

Please check any area in which you would be willing to serve and/or indicate ways you would like to contribute to the community of Wellspring.

Accounting

Administrative

Catering

Communications

Event Organization

Fundraising

Facilities Management

Family Recruitment

Legal

Tutor Recruitment

Tutoring/Teaching

By submitting this application we certify that the above answers are true and are made with no reservations and agree to submitting the Admissions Processing Fee of $40 (click the link to open in a new tab)

Upon acceptance to Wellspring Academy, the following conditions are required to secure acceptance in a classroom:

● A $250.00 registration deposit must be paid to Wellspring Academy and is non-refundable.

● Families must purchase an Alveary membership for $250 and provide proof of purchase.

● Sign the Enrollment Contract

First Name

Last Name

First Name

Last Name