River Roots Application Please complete this application if you wish to join our waitlist or to apply for our program. Child's name * Birthdate * Gender * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Desired start date * Previous schools attended (if any) and reasons for leaving * Child's health insurance provider * Special accommodations needed * Example: Diatery restrictions, allergies, etc. Tell us a bit about your family * Parent/Guardian 1 * First Name Last Name Email * Phone * (###) ### #### Parent/Guardian 2 First Name Last Name Email Phone (###) ### #### Schedule options Full day 8:00-5:00 Mornings 8:00-12:30 Is there anything else you would like us to know about your child or family? * Reasons why you are interested in River Roots Preschool * Program philosophy, convenience, etc. Please note * There is a $200 registration fee and refundable deposit that is due when your child has been accepted into our program. This is required for enrollment. The deposit is 1 months tuition, which will be returned after a 60 day termination notice has been given. I have read and understand Thank you!
