2026-2027 Siskiyou Roots Learning Collective

Siskiyou Roots Learning Collective Registration Deposit

Completing this form reserves your child's spot in the upcoming Siskiyou Roots Learning Collective program at Pacifica: A Garden in the Siskiyous.

A $200 non-refundable deposit is required to hold your child's place in the program. This deposit will be applied toward your tuition balance for the school year.

About Siskiyou Roots Learning Collective
At Siskiyou Roots Learning Collective, children learn through immersive, hands-on experiences across a 420-acre classroom of meadows, oak woodlands, ponds, gardens, and creeks. Our curriculum balances place-based and project-based learning, encouraging curiosity, creativity, collaboration, and connection to the natural world.

This coming year, students will explore Ancient Civilizations through storytelling, art, engineering, agriculture, mapping, and hands-on building projects. They will also imagine and create their own civilizations while exploring big questions such as:

What makes a strong community?
How do people live together well?
What values help communities thrive?
Students will learn how to become meaningful members of their own communities through service-learning projects, collaboration, leadership opportunities, and hands-on community engagement. They will study young people around the world who are creating positive change and explore what it means to become thoughtful, compassionate changemakers themselves.

At Siskiyou Roots, learning is active, meaningful, and rooted in wonder, giving children the opportunity to grow as thinkers, creators, leaders, and caring community members.

Program Information

Schedule:
Tuesday–Thursday, 9:30/10:00 a.m. – 3:00 p.m.

Ages:
10–13 years old

Math Instruction:
Daily math instruction will be provided by Amy Schlotterback.

Tuition:
Annual tuition will be divided into nine equal monthly payments from September through May. Your $200 deposit will be credited toward your tuition balance.

Student's Full Name

First NameLast Name

Birth Date

Students must be between 8 and 13 years old,

Are you from a home-based learning group?

Please share any learning challenges, support needs, learning preferences, strengths, or strategies that help your child thrive. This information helps us better understand and support your child's participation and success in the program.

What subjects, topics, or activities most interest your child?

.

Other learning subjects your child is interested in?

What grade was your student in during the 25-26 school year?

Parent/Guardian

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address:

Please provide any health information needed to maintain the health and safety of your child during their time at Pacifica. Health information shared will remain confidential. Especially note any health, emotional, or physical problems.

Please check any that pertain to your child's health:

Please share any information needed to best care for your child:

Applicable health concern needing treatment, any chronic illness, surgical procedure, activity restrictions or concerns, and any other needs we should know about (privacy needs, anxiety/nervousness, behavioral problems, etc). This information is confidentially shared with Pacifica staff to accommodate your child's needs.

DISCLAIMER & PARTICIPATION AGREEMENT

By enrolling your child in our programs, you acknowledge and agree to the following terms:

Our programs may involve physical activities and an increased level of risk. While we strive to create a safe and enriching environment for all students, our staffing and resources may not allow for the level of supervision and individualized support required by some children with specific behavioral or emotional needs.

We encourage all families to contact us in advance at education@pacificagarden.org to discuss their child’s needs so we can determine whether our program is an appropriate fit.

By proceeding with enrollment, you understand and agree that:

If your child’s behavior is consistently disruptive to the class, or
If their need for supervision exceeds what our staff can reasonably provide,

We reserve the right to cancel their enrollment, and you will be required to withdraw your child from the program.

These measures are in place to ensure a safe and supportive experience for all students.

Date

Parent Full Name

First NameLast Name

Signature

My Products

Deposit for Siskiyou Roots

(non refundable)

$200.00 Quantity

Processing Fee

$4.00

Enter coupon

Total

Credit Card

New Pacifica Use Permits

Pacifica Use Permits

Families may drop off and pick up students without purchasing a Pacifica Use Permit.

However, if family members plan to utilize Pacifica's trails, gardens, natural areas, or other facilities before or after school hours, we ask that they purchase a Pacifica Use Permit.

As a nonprofit organization, Pacifica's annual property taxes and insurance costs exceed $50,000 each year. Use Permit purchases help support the stewardship and maintenance of this special place, ensuring that Pacifica remains accessible to our community and future generations.

Thank you for helping us care for and sustain Pacifica for years to come.

General Annual Use Permit* – $40/yearYour 2026 hang tag helps fund trail upkeep, habitat preservation, and operation costs. Pay It Forward with a donation of $80, covering your permit and helping someone else who may not be able to afford it.
Equestrian Annual Use Permit* — $100/yearThis specialized equestrian rate helps offset the higher maintenance needs associated with horse and trailer access. Horses only allowed on designated trails.

General Day Use Pass* – $5 per Vehicle

Equestrian Day Use Pass* — $10 per TrailerPurchase a 1-day Pacifica Use Pass to enjoy what Pacifica has to offer.
Y

our annual permit is valid from January 1–December 31, 2026, from dawn to dusk (except during posted closures). If you selected “Pay Annually,” your permit will automatically renew each year)

Your permit is a tax-deductible donation. Your support keeps Pacifica wild, accessible, and thriving.

Release Forms:

We have started a new system for liability and media release forms, so you will only need to fill it out once for yourself or your dependent. These liability forms will be active for one year.

All participants must sign our release forms before attending any event at Pacifica.

CLICK HERE TO FILL OUT YOU OR YOUR CHILD'S LIABILITY FORM

If you have already signed this form, check the box below.

2026-2027 Siskiyou Roots Learning Collective

Student Information

Parent/Guardian Information

STUDENT HEALTH INFORMATION

DISCLAIMER & PARTICIPATION AGREEMENT

My Products

Credit Card