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 individual interest forms for each child. 
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Email *
Child First Name *
Child Last Name *
Which Wander & Root program(s) are you interested in your child attending? (Check all that apply.) *
Required
Child's Birthday *
MM
/
DD
/
YYYY
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? ( Limited scholarships are available. If you select "yes," a separate scholarship application form will be emailed to you. Priority is given to families that reside in Eagle Springs or Jackson Springs; and/or are experiencing family challenges; and/or are eligible for Medicaid, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP), Free or Reduced Price School Lunch, Temporary Assistance for Needy Families (TANF) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). *
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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