Join our Waitlist - Wild Roots Holistic Learning Center

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Prospective Child's Information

Prospective Students' Name(Required)

First Last

Students' Date of Birth(Required)

Desired Start Date

Desired Classroom

Desired Days

Desired Schedule

Wild Roots Location(Required)

Parent / Guardian 1 Information

Parent / Guardian 1 Full Name(Required)

First Last

Parent / Guardian 1 Phone Number(Required)

Email Address(Required)

Parent / Guardian 1 Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent / Guardian 2 Information

Parent / Guardian 2 Full Name

First Last

Parent / Guardian 2 Phone Number

Parent / Guardian 2 Address

Street Address Address Line 2 City State ZIP Code

Acknowledgement

Wait list students are students whose families have committed to start their child as soon as their desired classroom/schedule becomes available. The wait list is mainly utilized due to a classroom being at its full capacity. If the class you desire for your child is not at its full capacity, your child's spot can only be held for up to 30 days. Wild Roots Holistic Learning Center does not hold spaces on our wait list for current students with a desired start date that is in the future.

I understand and acknowledge that my $75 wait list fee holds my child’s place on the wait list, is non-refundable and will be applied to my $190 registration fee which is due at the time of my child’s enrollment.

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Payment

Non-Refundable Waitlist Fee(Required)

Price:

This $75 non-refundable fee secures your child’s spot on the waitlist and will be applied toward the $190 registration fee due at enrollment.

Payment Method(Required)

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Card Number Expiration Date Security Code Cardholder Name

Total

Waitlist Form

Prospective Child's Information

Parent / Guardian 1 Information

Parent / Guardian 2 Information

Acknowledgement

Payment

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