Rooted through Nature
Think. Feel. Homeschool.
STUDENT REGISTRATION FORM
Please fill out registration form and allow 24-48 hours for a follow-up call or email. If you desire immediate assistance please call or text 413-356-0557.
Which Program?
*
Red Maple - Ages 4 to 6
White Oak - Ages 7 to 13
American Elm - Ages 14 to 17
Unsure and Want a Consultation
Number of Children Enrolling?
*
One
Two
Three+
Student Information:
*
Additional Student Information
Additional Student Information
Parent Information:
*
Parent's Phone:
*
Home
Parent's Phone:
Cell
Can you receive texts at above number?
Yes
No
Email
*
example@example.com
Would you like our monthly newsletter that tells you what your child is learning?
*
Yes
No
Parent Information:
Parent's Phone:
Home
Parent's Phone:
Cell
Can you receive texts at above number?
Yes
No
Email
example@example.com
Would you like our monthly newsletter that tells you what your child is learning?
Yes
No
Emergency Contact
*
Full Name:
Phone:
Can the Emergency Contact listed pick-up the child(ren)?
*
Yes
No
Additional Pick-up Permission *Other than previously listed*
*
Full Name:
Phone:
Tell Us About Your Child!
Please answer the questions below so we can get to know your child(ren) better. *If enrolling multiple children please include their names in your response.
Are you new to homeschooling in Massachusetts? If not, tell us how long you have been homeschooling for, or your child's previous schooling experience (public, private, charter, co-op, etc).
*
What grade level is your child(ren) studying at?
*
What type of learner is your child? Visual, Auditory, Kinesthetic, or a little of all and more.
**Only mentioned a few broad commonly identifiable types**
Will your child work on a curriculum or will they participate in our STEAM unit studies?
*For White Oak and American Elm programs only.*
Are there any known learning/behavioral disabilities, IEP, 504, or special needs?
*
*We only ask to ensure we are able to adequately and safely serve your child.*
Do you have any specific goals for your child in this program? If enrolling more than one student please add names with your response.
*
Is there anything else you can tell me about your child that you think would help me support his/her learning? What are their strengths and weaknesses both academically and socially?
Ex: Are they shy, Do they struggle in reading, etc.)
Please add anything you think would benefit us in getting to know or teach your child. We welcome any information you choose to share about their family, lifestyle, school styles, or anything else.
How did you hear about us?
*
Facebook, Instagram, Google... If from a friend, please write their name for both to receive $10 off tuition!
Rooted through Nature Contact Info
Number: 413-356-0557 Email: info@rootedthroughnature.com
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