2022-2023 Re-Enrollment

We can’t believe it’s already here! Please complete one application for each student applicant for the 2022-2023 homeschool program.

Name

Student's Legal Name

First Name

Last Name

Student's Preferred Name

Telephone Numbers

Primary Phone Number

(###)

###

####

Secondary Phone Number

(###)

###

####

Email Address

Primary Email

Secondary Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Biographical Information

Birthday

YYYY

Race/Ethnicity

School Information

Information regarding your child's previous/current school.

School Name

School Phone Number

(###)

###

####

Family Information

Parent/Guardian's Name

First Name

Last Name

Relationship to student applicant

Parent/Guardian's Name

First Name

Last Name

Relationship to student applicant

Who does the student applicant live with?

Does the student applicant have a second household?

Legal mumbo-jumbo aside – we’re asking you to type your full legal name below (in place of your signature), to let us know that you kept it honest! We want to get to know your child to be able to find the place that best suits them and your family.

2022-2023 Re-Enrollment

WILLOW ROOTS - LEARNING CENTER