Admissions Agreement
Wild Roots Holistic Learning Center, Inc. is licensed under the California Department of Social Services to provide education and care for up to 120 children. For this purpose, “childcare” means non-medical care for children who are in need of age-appropriate activities, education, and supervision. We currently offer care and supervision for children aged 6 weeks through 6 years under Title 22 provision (101169).
Please read the 2024-2025 Admissions Agreement thoroughly before filling out the form below.
View 2024-2025 Admissions Agreement
This contract is made between and Wild Roots Holistic Learning Center, Inc. for the care of .
Birthdate:
Child's Gender: Male Female
PARENT/GUARDIAN INFORMATION
PRIMARY CONTACT
Parent/Guardian 1:
Relationship to Child:
Home Phone: Cell Phone:
Home Address:
City, State, Zip Code:
Email Address:
SECONDARY CONTACT
Parent/Guardian 2:
Relationship to Child:
Home Phone: Cell Phone:
Home Address:
City, State, Zip Code:
Email Address:
TUITION RATES & FEES (Monthly Rates Per Classroom)
Please complete the Tuition Rates & Fees form and upload it below.
Click here to download: 2024-2025 Tuition Rates & Fees
Upload completed form here:
Consent for Photography and Information for Publication:
Please Initial One Line Only
➢ By initialing here, you hereby give permission for professional and appropriate photography and/or video footage to be taken of your child and used in any capacity listed in the Admissions Agreement.
Initial Here
➢ By initialing here, you hereby do not give permission for any photography or video footage to be taken of your child whatsoever as outlined in the Admissions Agreement.
Initial Here
I have read, understand and agree to all the terms outlined in Wild Roots' 2024-2025 Admissions Agreement.
Name of Child:
Mother's/Guardian's Signature:
Date:
Father's/Guardian's Signature:
Date:
Parent Handbook and Agreements
Please read the entirety of the Parent Handbook before signing the Parent Acknowledgement, Illness Policy, Medication Policy and Immunization Policy below
Click here to read: 2024-2025 Parent Handbook
Illness, Medication and Immunization Policy Agreement
I HAVE READ AND UNDERSTAND WILD ROOTS HOLISTIC LEARNING CENTER’S POLICIES ON ILLNESS,
MEDICATION, AND IMMUNIZATIONS.
Name of Child:
Parent/Guardian Signature:
Today's Date:
Parent Acknowledgment
By signing below, you are acknowledging that you have read all of the information within the Wild Roots Parent Handbook and agree to adhere to all of our procedures and policies.
I HAVE READ AND UNDERSTAND WILD ROOTS HOLISTIC LEARNING CENTER’S POLICIES AND PROCEDURES AND WILL
ADHERE TO ALL ITEMS OUTLINED IN THIS PARENT HANDBOOK.
Name of Child:
Parent/Guardian Signature:
Today's Date:
Nut-Free Policy Agreement
Please read the entirety of our Nut-Free Policy Agreement before signing below.
Click here to read: 2024-2025 Nut-Free Policy
BY SIGNING BELOW, YOU ARE AGREEING WITH AND COMMITTING TO YOUR ADHERENCE TO THE POLICY STATED IN THE 2024-2025 NUT-FREE POLICY AGREEMENT
Child's Name:
Parent/Guardian Name:
Parent/Guardian Signature:
Today's Date:
LineLeader App Usage Agreement
Please read the entirety of our LineLeader App Usage Agreement before signing below.
Click here to read: 2024-2025 LineLeader App Usage Agreement
BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND AGREE TO ABIDE BY THE 2024-2025 LINELEADER APP USAGE POLICY OUTLINED IN THE AGREEMENT.
Child's Name:
Parent's Name:
Parent's Signature:
Today's Date:
Infant Service Plan
Is your child an infant (6 weeks-12 months)?
If this form is not for an infant, please click "Next" and go to the next section. If your child is an infant, click yes and fill out the Infant Service Plan
Complete the 2024-2025 Infant Service Plan and upload completed form down below.
Download here: 2024-2025 Infant Service Plan
Click "Choose File" to upload completed Infant Service Plan
Additional Programs
Please fill out any/all applicable forms below.
Wild Olympians Registration Form
Student Name: Age:
Parent's Name:
T-Shirt Size:
Wild Olympians Waiver
I, , the parent/guardian of the registrant, a minor,
acknowledge the possibility of physical injury associated with this outdoor sports activity and release Wild Roots and its staff members from all liability for any injuries sustained while participating in Wild Olympians activities.
BY SIGNING BELOW, I AGREE WITH THE STATEMENT ABOVE.
Parent's Signature:
Today's Date:
Private Music Lessons Contract and Policies
Click here to read: 2024-2025 Private Music Lessons Contract and Policies
Student Name: Age:
Parent's Name:
Month + Year Beginning Lessons:
Check all that apply: Vocals
By signing this contract, you are agreeing to allow Wild Roots’ music teacher to remove your child from the classroom during their scheduled 30-minute lesson once a week, each week, until this contract is terminated. There, your child will engage in a private music lesson with a music teacher in our music room. Following their lesson, your child will be returned to their classroom immediately to resume classwork.
By signing this contract, you are agreeing to a 1- month minimum commitment. Following your 1-month
commitment, we simply require a 2-week written notice for change or cancellation of music lessons.
We reserve the right to discontinue lessons and cancel this contract any time at our own discretion.
BY SIGNING BELOW, YOU ARE COMMITTING TO PAYMENT OF MONTHLY PRIVATE LESSONS, FOR A DURATION OF 1-MONTH MINIMUM BEGINNING ON THE DATE STATED ABOVE.
Parent/Guardian Name:
Parent/Guardian Signature:
Today's Date:
2024-2025 Scholarship Renewal Application
Is your child currently receiving scholarship benefits from Wild Roots? NoYes
If no, click next to go to the submission page.
You are eligible to apply for renewal of your scholarship. Please complete and upload the completed form below.
Click here to download: 2024-2025 Scholarship Renewal Form
Upload Completed Scholarship Application
Please note that, while we try and grant scholarships to as many of our students as we can, your application does not guarantee approval. Wild Roots reserves the right to approve or deny any applications for scholarship. We will notify you of our decision via email.
Please make sure that you have thoroughly filled out this form. If you have any questions, please email Ms. Lidia at lidia@wildroots.com. Any additional or supplemental forms can be uploaded below. Once everything is completed, you may click submit below.
Upload any supplemental forms below
