Parent & Student Statement

The Parent & Student Statement form is provided to gather information about your child and your family's expectations.

Please complete the form below. Required fields marked with an asterisk *

Child's Information

First Name*

Last Name*

Why are you interested in having your child change schools at this time?

What are your child's greatest interests?

What are your child's greatest strengths?

What does your child do for physical activity?

Why do you think Hampshire Country School might be a good match for your child?

What behaviors or idiosyncrasies contribute to your child's challenges at SCHOOL?

What behaviors or idiosyncrasies contribute to your child's challenges at HOME (bedtime routines, food preferences or restrictions, etc)?

Does your child show over-sensitivity or under-sensitivity to touch, light, sounds, food, clothing, or coordination?

What are YOUR expectations for your child's first year at Hampshire Country School?

What are YOUR CHILD'S expectations for his first year at Hampshire Country School?

What is your greatest concern about your child's time at a boarding school?

Signature Authorization

Signature of Parent / Guardian*

Date*

We, the undersigned, understand that any information furnished in support of this application shall be complete and confidential, and shall not be disclosed to anyone, and the Head of School may, for official purposes at her discretion, disclose any part of all thereof to such persons as she deems advisable. We further attest that all statements made herein are true and complete, and understand that any false statements or disclosures could result in the dismissal of your child if enrolled.