Application Santa Barbara Program archived

Application
Santa Barbara

To apply with interest to enroll, the first step is to complete and submit this application. Once the application is received, it will be reviewed, the parent/s will be contacted, and a visit to the program will be arranged.

Applicants will be awarded space on a first come first serve basis, with 4 or 5 day enrollment given priority for placement. All other applications are accommodated according to space available and may be placed on a waiting list.

A child's space is held once the $300 enrollment and materials fee, and signed enrollment agreement are received.

Contact with questions: Kolmi Majumdar, Administrative Director, registrar.wildroots@gmail.com

Wild Roots Forest School - Santa Barbara Application

* Indicates required field

Child's First Name *

Child's Last Name *

Gender *

Male Female

Child's Date of Birth *

Program Interest + Number of Days *

Parent/Guardian Name *

First

Last

Street Address *

City/Town *

State *

Zip Code *

Email *

Cell Phone Number *

Additional Phone Number *

Occupation/Employer *

Two parent families should be sure to fill out the second parent/guardian information below for a complete application.

Parent/Guardian Name *

First

Last

Email *

Street Address if different from above *

City, State and Zip Code *

Occupation/Employer *

Cell Phone Number *

Phone Number *

Does your child currently attend a school program? If so, please share which one and something about the program and how it's going or if transferring out of it, please share why. *

Please tell us who lives in the house with you? Please share their names, ages, and relationships (friends, grandparents, siblings, housemates, etc.) *

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

Medical Health - Please list any medical needs your child may have. *

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

Any childhood illnesses? 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 an average Week Day? *

How many hours of visual media (TV, computer, videos) does your child experience on an average Weekend Day? *

Please describe what type/s of visual media are included. *

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

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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ApplicationSanta Barbara

Wild Roots Forest School - Santa Barbara Application

Application
Santa Barbara