Rooted Lyceum Intake Form 2026/2027

Rooted Lyceum Intake Form 2026/2027

Intake form for children enrolling in our Rooted Lyceum for September 2026-June 2027
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Program Days
What drew you to Rooted Lyceum?(What about our program resonated with you or your child?)
What are you hoping your child will gain from this experience?(You might consider social, emotional, academic, or developmental goals.)
How does your child typically learn best?(e.g., through movement, observation, hands-on experiences, structure, etc.)
What has your child’s experience been in other learning environments (school, childcare, homeschool, etc.)?What worked well? What didn’t?
Are there any specific challenges, sensitivities, or needs we should be aware of to better support your child?(This may include sensory needs, transitions, communication, etc.)
What does a successful year at Rooted Lyceum look like for your family?(How will you know this was the right fit?)
Is there anything else you’d like us to know about your child?(Strengths, interests, personality, anything meaningful)
Commitment & Understanding

Program Commitment

Rooted Lyceum is a consistent, relationship-based program. Children benefit most from regular attendance and time to settle into the rhythm of the land and community.
Deposit Policy & Agreement

To secure your child’s space in Rooted Lyceum, a non-refundable deposit of $300 is required upon registration.

• This deposit is applied toward your child’s final month of tuition

• The deposit confirms your commitment to the program and reserves your child’s place

• As spaces are limited and held specifically for each family, the deposit is non-refundable and non-transferable
Payment Understanding

By registering, families acknowledge that they are committing to a monthly tuition structure for the duration of the program year.
First Name Last Name
Date
Signature

My Products

Deposit for Rooted Lyceum

$300.00 CAD Quantity

Total

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

Should be Empty: