Take a step towards a brighter future
for your child!

Initial Contact Form

Thank you for taking this first step to see if the New Song Leadership Academy might be a blessing to your child. Please complete the contact form below.

Parent / Grandparent / Guardian Information

Your Name

Relationship to child (required)

Phone Number (required)

Address

City

State

Zip

Child's Information

Child's Name (First/Middle/Last): (required)

Gender

male
female

Date of birth: (required)

Grade

Additional Questions

Please describe what your goals are for enrolling your child in the New Song Leadership Academy. (required)

Please describe any social, emotional, or behavioral difficulties your child has had. (required)

Please describe any medical conditions that your child has had in the past 5 years. (required)

How did you hear about New Song? (required)

Security Test (required)

The Security Test is invalid. Try again.

Take a step towards a brighter future for your child!

Initial Contact Form

Take a step towards a brighter future
for your child!