Wild Roots 24 Registration Form

Wild Roots Learning Registration

Fill out this form carefully for registration. To ensure class sizes are small, your place will be held upon registration and you are agreeing to be financially liable for the entire Fall term. No refunds will be given to maintain the integrity of our program.
Student First and Last Name
Student Date of Birth

MonthDayYear
Date
Please list any allergies
Please list any accommodations or supports your student may need
Please select the appropriate grade level for your student

Pre KindergartenKindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th grade8th gradeHigh School
Which Day of the week(s) are you wanting to attend?

MondayTuesdayWednesdayThursday
What kind of a schedule are you wanting for your student?

Morning half-dayFull DayAfternoon half-day
Has your student participated in any classroom type courses in the past? Feel free to elaborate
What was your student's prior school of attendance?
Who should we contact regarding this registration?
Primary Contact Name
Primary Contact Email
example@example.com
Billing Address
Primary Contact Phone Number
Please enter a valid phone number.
Please list any additional adults who have permission to pick up your student :
Name
Phone
Relationship
Name
Phone
Relationship
How did you hear about us
Please check any additional services or activities you interested in for the 24-25 School Year

Field TripsFamily TripsAfterschool CareFridays on the FarmParents Night OutParent Teacher Organization4H ClubGirls Who Run ClubCommunity Garden-Garden Bed RentalSpecial Events
Billing Information

Private PayCharter School Voucher
If you will be using vouchers please indicate the charter school
Wild Roots Learning Center is not responsible for notifying the charter school that a purchase order or invoice for payment or reimbursement will be sent, this is the responsibility of the family. If you need help with this process, please reach out sooner rather than later so we can ensure you are not held financially responsible. If charter school funds are not received by the end of the first billing cycle. For Private pay, or private pay portions- cash, check to Wild Roots Learning Center, ACH payments will not incur additional fees, however any credit card transaction will incur a 3% charge. Billing cycles begin at the beginning of each month.

To ease the financial burden, we offer payment options for families enrolling in at least a full day and paying privately. If you are interested in this option and proposed payment plan on your payment confirmation form. Early Elementary students will be charged by the month regardless.

Once courses have been selected, to reserve space in the course, a non refundable $150 Enrollment fee is collected by cash or check, once a year in addition to course tuition, if this has already been paid this year- - your space will be reserved upon receipt of your enrollment form. Because we limit class sizes, we do not offer refunds once enrollment has been processed (if space is available in alternative courses we may allow transferring to another class).
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