25-26 Wild Roots Registration Form

Wild Roots Learning Center Student Registration 25-26

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 semester. Student registration fees are due upon reciept of the invoice and class selecction forms will not be sent until this is received. Invoices for your classes will be sent seperately.
Student First and Last Name
Student Date of Birth

MonthDayYear
Date
Please list any allergies
Please list any IEP or 504 accommodations or supports your student may need to be successful in our program or would benefit our teachers to know.
Please select the appropriate grade level for your student

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

MondayTuesdayWednesdayThursday
Our schedule is designed to focus on hands-on core classes in the morning and community based electives in the afternoons. Students benefit the most both socially and academically from spending the entire day with us, and for early elementary (PK-K) we highly recommend at least two half days to establish a routine and a sense of security at Wild Roots. What schedule are you hoping to secure for your child this semester?

Morning half-dayFull DayAfternoon half-day
Does your child have any classroom or enrichment center experience? If so, where?
What are your primary goals for your child at Wild Roots? Academics? Social? Both? What is your expectation of your child while attending Wild Roots?
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 CareParents Night OutParent Teacher OrganizationSpecial EventsClubs (4H, Girls Who Run, Art & Music, etc)Private Music Lessons (Guitar, Piano, Ukulele, Bass, Voice)
Billing Information

Private PayCharter School Voucher
If you will be using vouchers please indicate the charter school (if you do not know yet, that is okay, there will be more opportunities to get us this information)
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 5% charge. Billing cycles begin at the beginning of each month. ACH Automatic payments must be accepted for any payment plan, unless other arrangements have been made directly with Wild Roots.

To ease the financial burden, we offer payment options for families, with options of 2, 3 or 4 equal payments. This must be set up and accepted through the automatic payment request. For any cancelled automatic payment, returned payment or missed payment, a late fee will be incurred AND the payment plan is no longer valid and payment in full for the remaining balance will be due. If you are interested in this option, this shall be reflected on your Estimate and Acknowledgement, and request for automatic payment must be accepted within 48 hours of receiving the request. All PO's and Invoices will be done on a monthly basis for Early Elementary, and if your charter requires this of us (all are different and will be noted on your invoices).

A non-refundable $150 enrollment fee per child (with a maximum of $350 per family) is collected by cash or check, once a year, prior to course selection. 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).

5% discount is given to fully private pay with automatic payments.
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