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*

Sowing Seeds - Elementary ClassesBranching Out - Design-Your-Own ClassCreate and Play - Kindergarten ClassRoots - Support and Consultation
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.*

YesNo
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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