Interest Form: Wander & Root
All information provided will be kept confidential.

One form is required for every child. If you would like to apply for multiple siblings, please submit information for each child.
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Child First Name *
Child Last Name *
Which Wander & Root program(s) are you interested in your child attending? (Check all that apply.) *
Obligatoria
Child Birthday *
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MM
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Parent/Guardian Name(s) *
Physical Home Address *
Mailing Address (if different)
Phone Number *
Additional Phone Number
Email *
Confirm Email *
Would you like to be considered for a tuition scholarship? (Scholarships are intended for families experiencing financial challenges. Priority is given to families living in Eagle Springs and Jackson Springs.) *
Is your child currently receiving any kind of therapy? (Such as mental health, developmental services, occupational, ABA, speech, or other?) Please describe. *
Please tell us more about your child! What is s/he like and interested in? *
Has your child attended any early childhood or school-age education programs in the past? Please describe. *
Why do you want your child to attend Wander & Root? *
How did you hear about us? (Please put names of friends who referred you so we can thank them, or the locations of any advertising so we know what works!)
Do you have any additional questions or comments?
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