Application for Enrollment

Mighty Roots Academy

The mission of Mighty Roots Academy is to provide active, multiage learning in a nature rich environment.

Mother's/Guardian's Name *

First Name Last Name

Father's/Guardian's Name

First Name Last Name

Address *

City *

State *

Zip Code *

Child(ren) reside at this address with: (mark one) *

Both Parents Mother Father Guardian(s)/Other

Home Phone Number

Phone numbers and emails for communication purposes (Please note that any email provided will receive at least monthly emails):

Mother's/Guardian's Phone Number *

Please enter a valid phone number.

Mother's/Guardian's Email:

Father's/Guardian's Phone Number

Please enter a valid phone number.

Father's/Guardian's Email:

Mark preferred direct communication option regarding your child(ren).

Mother's/Guardian's Cell Mother's/Guardian's Email Father's/Guardian's Cell Father's/Guardian's Email

What type of enrollment?

Returning family New family

How many children will you enroll?

Mighty Roots Academy is an enrichment program, and as such we recommend that students enroll for a maximum of 3 days

Will your children all participate in the same program?

Yes No

Program(s) in which child(ren) will participate:

Homeschool Academy Creative Options Discovery Days

Children's Names and Birthdays *

Children's Names, Birthdays and Program Days *

With this Application you MUST:

Mighty Roots Academy Phone: 816-873-2022

Address: 3600 Blue Ridge Blvd.

Grandview, MO 64030

Email for Homeschool Academy: tracy@mightyrootsacademy.com

Email for Creative Options/Discovery Days: renee@mightyrootsacademy.com