ENROLLMENT APPLICATION

Please complete the following Enrollment Application for Watershed Schoolhouse's 1-Day Tributaries Program. If you are applying for multiple children (e.g., siblings), you can use one application form. There is a $25 application fee per student (with a needs-based waiver). Plan to spend about 10-15 minutes on the application, with additional time for each additional child.

If you have questions, please email: admin@watershedschoolhouse.org.

PARENT/GUARDIAN 1

Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Relationship to Student Applicant*

Profession*

How did you hear about us?*

Please specify

Reason for Applying*

Please briefly describe your interest in Watershed Schoolhouse

Add Another Parent/Guardian*

Please select 'yes' if there are multiple parents in the household or with shared custody

PARENT/GUARDIAN 2

Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Relationship to Student Applicant*

Profession*

STUDENT 1

Name*

First NameLast Name

Date of Birth*

Current Age (in years)*

Number only

Gender*

Please Specify (Gender)*

Race/Ethnicity (Please check ALL that apply)*

American Indian or Alaska NativeAsian/Asian American/Asian-DescentBlack/African American/African-DescentLatinx/South-, Central-, North-American DescentMiddle Eastern North African (MENA)Native Hawaiian or Other Pacific IslanderOther IndigenousWhite/Caucasian/European-DescentOther

Language(s) Spoken at Home*

Please list primary language first. Separate languages with commas.

Current School*

This can include Pre-K programs (even if part-time). If not yet enrolled in any program, type 'none.' If homeschooling, type "homeschool."

Current Grade*

Does your child live in one home with both parents*

Please describe your child's living arrangement.*

(i.e., housing, custody agreements, etc.)

Health & Development*

Please describe anything in your child's health or development that is educationally significant. Note: A complete health form will be required for enrollment. This question is for a broad understanding (e.g., major diagnoses or illnesses, ADA requirements, etc.) If none, type 'none.'

Educational Support*

Please describe any known educational support that your child needs or has required in the past (e.g., learning disabilities, individual education plan (IEP), special services, etc.). If none, type 'none.'

Media Use*

Please describe your child's use of electronic media (e.g., phones, tablets, computers, TV, movies, social media, etc.). Please include the type of use and amount (e.g., hours per day, week, etc.). If none, type 'none.'

Is there anything else you wish to share?

Apply for another Child/Sibling*

STUDENT 2

Name*

First NameLast Name

Date of Birth*

Current Age (in years)*

Number only

Gender*

Please Specify (Gender)*

Race/Ethnicity (Please check ALL that apply)*

American Indian or Alaska NativeAsian/Asian American/Asian-DescentBlack/African American/African-DescentLatinx/South-, Central-, North-American DescentMiddle Eastern North African (MENA)Native Hawaiian or Other Pacific IslanderOther IndigenousWhite/Caucasian/European-DescentOther

Language(s) Spoken at Home*

Please list primary language first. Separate languages with commas.

Current School*

This can include Pre-K programs (even if part-time). If not yet enrolled in any program, type 'none.'

Current Grade*

Does your child live in one home with both parents*

Please describe your child's living arrangement.*

(i.e., housing, custody agreements, etc.)

Health & Development*

Please describe anything in your child's health or development that is educationally significant. Note: A complete health form will be required for enrollment. This question is for a broad understanding (e.g., major diagnoses or illnesses, ADA requirements, etc.) If none, type 'none.'

Educational Support*

Please describe any known educational support that your child needs or has required in the past (e.g., learning disabilities, individual education plan (IEP), special services, etc.). If none, type 'none.'

Media Use*

Please describe your child's use of electronic media (e.g., phones, tablets, computers, TV, movies, social media, etc.). Please include the type of use and amount (e.g., hours per day, week, etc.). If none, type 'none.'

Is there anything else you wish to share?

Apply for another Child/Sibling*

STUDENT 3

Name*

First NameLast Name

Date of Birth*

Current Age (in years)*

Number only

Gender*

Please Specify (Gender)*

Race/Ethnicity (Please check ALL that apply)*

American Indian or Alaska NativeAsian/Asian American/Asian-DescentBlack/African American/African-DescentLatinx/South-, Central-, North-American DescentMiddle Eastern North African (MENA)Native Hawaiian or Other Pacific IslanderOther IndigenousWhite/Caucasian/European-DescentOther

Language(s) Spoken at Home*

Please list primary language first. Separate languages with commas.

Current School*

This can include Pre-K programs (even if part-time). If not yet enrolled in any program, type 'none.'

Current Grade*

Does your child live in one home with both parents*

Please describe your child's living arrangement.*

(i.e., housing, custody agreements, etc.)

Health & Development*

Please describe anything in your child's health or development that is educationally significant. Note: A complete health form will be required for enrollment. This question is for a broad understanding (e.g. major diagnoses or illnesses, ADA requirements, etc.) If none, type 'none.'

Educational Support*

Please describe any known educational support that your child needs or has required in the past (e.g., learning disabilities, individual education plan (IEP), special services, etc.). If none, type 'none.'

Media Use*

Please describe your child's use of electronic media (e.g., phones, tablets, computers, TV, movies, social media, etc.). Please include the type of use and amount (e.g., hours per day, week, etc.). If none, type 'none.'

Is there anything else you wish to share?

* Application Fee Waiver — If paying an application fee is a financial barrier for your family, please enter the coupon code: WAIVER (all caps). Application fees support the administrative costs of the enrollment process.

Note: if your form is not submitting properly or shows an "error" message, please go back and check that all required fields are complete.

My Products

Application Fee*This fee helps to cover the administrative costs of the enrollment process.

$25.00 Number of Students Applying
Item subtotal:$0.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

TRIBUTARIES ENROLLMENT APPLICATION