Farm Explorer Interest Form – Building Connections

Child's Name *

First

Last

Age *

Date of Birth *

Current Grade for the 2026/2027 School Year *

Parents Name *

First

Last

Email *

Phone Number *

Do They Attend any Other Homeschool Group/Co-Ops? *

Does Your Child Have a Diagnosis/Diagnoses? *

If Yes, Please List Below

Has Your Child Ever Had a Full Psychoeducational Evaluation? *

If Yes, When?

Have They Ever Attended School? *

IE: Private/Public/Charter

If Yes, Where and Dates Attended

What Are Your Child's Strengths? *

Academically, Socially & Emotionally

What Are Your Child's Needs? *

Academically, Socially & Emotionally

Can Your Child Work Within a Group Setting with Some Support? *

If Yes, What Supports Are You Thinking They Need or Respond Best To?

What Would be Your Goals for Group? *

Any Other Information?

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