2025-2026 Woven Roots Girls Group Application
PLEASE READ BEFORE FILLING OUT:

This form is the first step in applying to our new Girls Group offering. Please fill out this form, after going through the application I will be in touch and request a deposit to hold your daughter's spot. 
If I do not know your daughter, it will most likely be necessary to meet before being accepted - this is to ensure the girls are all in a similar developmental stage.

More information on the program can be found on my website HERE. 

All information is kept confidential.
   
Thanks so much for expressing your interest via this form. I will reach out to you shortly with the next steps for the enrollment process. 

With Love,
Kate 
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Email *
Your name and relationship to child *
Your phone number *
Additional parent or caregiver name and relationship to child *
Additional parent or caregiver phone # and email address *
Your daughter's name *
Your daughter's current age  *
Your daughter's school for 2025-2026 *
Your daughter's gender identity  *
What interests you about Woven Roots girls circle?  *
What activities does your daughter currently do? *
Has your daughter started her menstrual cycle?  *
Describe your daughter in 5-10 words *
What challenges do you see your daughter currently facing?  *
Please describe your daughter's social life *
What types of activities is your daughter drawn to?  *
Required
What are your family values on Media & Technology? How much technology does your daughter have (daily/weekly) and what types? (cell phone, ipad, computer, etc) *
EMERGENCY CONTACT - Name & Relationship (must be someone other than a parent):
 *
EMERGENCY CONTACT - Phone Number:
 *
MEDICAL Please list below any allergies, including insects, medications, foods, and environmental allergens like pollen, that your child has and describe the reaction and severity, and if any medication is required. Otherwise, please enter "none": *
Please list and explain below if your child has, or has had any medical or mental health conditions that we should know about:
 *
Please indicate which payment tier is affordable to your family - all costs are per 9 session block and include material fees.
 *
Anything else you would like me to know?
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