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Parent & Student Statement Form

Parent / Guardian & Student Statement Form

The Parent / Guardian & 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*

Answer Required

Last Name*

Answer Required

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

Answer Required

What are your child's greatest interests?

Answer Required

What are your child's greatest strengths?

Answer Required

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

Answer Required

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

Answer Required

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

Answer Required

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

Answer Required

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

Answer Required

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

Answer Required

SIGNATURE AUTHORIZATION

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 discloseures could result in the dismissal of your child, if enrolled.

Signature of Parent / Guardian*

Answer Required

Date*

(mm/dd/yy)

Answer Required