Application

Application
Eastern Sierra

Once an application is received, it is reviewed by the class teacher and the family will be contacted with further information.

Applications received will be awarded on a first come, first serve basis, depending on space available. Once the current class is filled, applicants will be placed on a waiting list and contacted as soon as a space becomes available.

Once you have been offered an enrollment agreement, your child's space will be held with receipt of the signed enrollment agreement and the $350 enrollment and materials fee.

Payment of fees by check to: Wild Roots Forest School, 6249 Momouth Ave, Goleta, CA 93117
Tuition in full by check, or tuition payment plans through FACTS tuition management program.

Please direct all questions regarding enrollment, availability, scheduling visits, or tuition assistance to
Erin Boehme, Eastern Sierra Program Director wildrootseasternsierra@gmail.com

Wild Roots Forest School - Eastern Sierra Application

* Indicates required field

Child's Full Name *

Parent/Guardian Name *

First

Last

Gender *

Male Female

Child's Birthday *

Phone Number *

Street Address *

Cell Phone Number *

Email *

City and Zip Code *

Occupation/Employer *

Parent/Guardian Name *

First

Last

Email *

Phone Number *

Cell Phone Number *

Street Address if different from above *

Occupation/Employer *

City and Zip Code *

Does your child currently attend a school program? if so, please explain *

Please tell us who lives in the house with you? Adults? Siblings? Friends? Other children, etc? *

Are there any areas you feel your child might need assistance in? *

Medical History- Please list any medical needs your child might have *

Does your child take medication? If so, what kind and what dosage? *

Any childhood illnesses? (i.e. chicken pox, whooping cough..)Please name type, duration, severity and approx. age *

Please list any allergies: (Foods, Environmental, Medications, Insects) as well as frequency, duration and treatments *

How many hours of visual media (TV, computer,videos) does your child experience on Weekdays? *

Weekends? *

Describe what type? *

What kinds of experiences has your child had in nature and what was the response? *

Enrollment Options *

Preschool 4 days: Tues, Wed, Thur, Fri Preschool 2 days: Tues & Thur Kinder class: Mon - Fri (4 1/2-7 yr olds)

What is the best way to contact you? *

Thank you for taking the time to complete our application. Please click the SUBMIT button below.

Wild Roots does not discriminate on the basis of gender, ethnicity, religion, or national origin in its admission policy or conduct of its educational programs.

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ApplicationEastern Sierra

Wild Roots Forest School - Eastern Sierra Application

Application
Eastern Sierra