New Student Application
Child's Name
First Name
Last Name
Date of Birth
Gender
Age of Child by Preferred Session Start
Program Interest (Check All That Apply)
Mixed Age, 2 Days
Mixed Age, 3 Days
Mixed Age, 4 Days
Mixed Age, 5 Days
Please list top 3 ideal schedules, in order of preference:
Other
Parent/ Guardian 1 Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation/ Employer
Email Address
example@example.com
Parent/Guardian 2 (When Applicable)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation/ Employer
Email Address
Marital Status of Parents
Married
Domestic Partnership
Divorced
Separated
Widowed
Other
What is your child's living situation? (Who do they live with and what are the names, ages, and relationships of those living with your child?)
Please list any allergies or special medical needs your child may have and how they are managed.
Does your child require regular medication? If so, what kind and what dosage?
Please list any other relevant medical history.
Has your child previously attended a school/ group care environment? If so, where and if care has ended, why?
Are there any ways in which you feel your child needs special assistance?
What interests your child? What do you love about them?
What challenges your child?
What do you hope for your child to gain from an outdoor education?
Any other questions, comments, or relevant information:
I understand:
my child must be potty-trained before beginning the program.
the program meets at various, alternating locations throughout Santa Barbara and Goleta.
Application Fee ($35) payable by:
Venmo or Zelle at director@athousandmorningssb.com
Submit
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