Homeschool Class Inquiry

Homeschool Class Inquiry
Child's Information
Child's Full Name

First NameLast Name
Birth Date

MonthDayYear
We are interested in the following programs
Family Information
Sibling's Full Name

First NameLast Name
Birth Date

MonthDayYear
Sibling's Name
Sibling's Full Name

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent or Legal Guardian Information
Parent/Legal Guardian Full Name

First NameLast Name
Relation
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parents Email
Work Phone

Area CodePhone Number
Parent/Legal Guardian 2 Full Name

First NameLast Name
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Health Information
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
I would like to receive your e-newsletter. Please add me to your mailing list.
Please describe our homeschooling philosophy or style
Please describe what you are hoping to get out of classes at Creative Roots
Please describe your interest in participating in a community at Creative Roots
Please initial that you understand that homeschool classes at Creative Roots require a year long commitment in order to create and maintain a consistent environment for the children
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