Fall 2025 Application

Parent Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone *

Email *

Address

City

State

Country

Postal code

Secondary Guardian Name

Secondary Guardian Phone

Secondary Guardian Email

Student Information

Name of Student 1 *

Date of Birth *

Grade Applying For *

Campus Applying For *

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Would you like to add a second student? *

Yes

No

Name of Student 2

Date of Birth

Grade Applying For

Campus Applying For

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Would you like to add a third student?

Yes

No

Name of Student 3

Date of Birth

Grade Applying For

Campus Applying For

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Would you like to add a fourth student?

Yes

No

Name of Student 4

Date of Birth

Grade Applying For

Campus Applying For

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Would you like to add a fifth student?

Yes

No

Name of Student 5

Date of Birth

Grade Applying For

Campus Applying For

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Would you like to add a sixth student?

Yes

No

Name of Student 6

Date of Birth

Grade Applying For

Campus Applying For

Allergy Information

Medical Conditions/Current Medications

Special Needs/Accommodations

Attach Medical & IEP Records

Family Background & Philosophy

How did you hear about Deeply Rooted Academy? *

Previous Schools or Homeschooling Information: *

Has your child skipped or repeated a grade? *

Yes

No

If yes, please explain:

Please explain why you have chosen Deeply Rooted Academy for your child(ren). *

How would you describe your understanding of the educational philosophy of Charlotte Mason? *

Do you have any unique expectations that you had for your child(ren) when choosing Deeply Rooted Academy as opposed to another school? *

How can Deeply Rooted Academy best care for your child(ren)? *

How would you describe your child(ren)'s temperament? *

What methods motivate your child(ren) to learn more? *

Are you involved in a local church? *

Yes

No

If yes, please provide the name of your church:

Parent Handbook

Parent handbook acknowledgment: *

I have read, understand, and agree to the Deeply Rooted Academy Parent Handbook and policies.

Application Fee

$50 per student, non-refundable *

$ 50

$ 100

$ 150

$ 200

$ 250

$ 300

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Parent Signature

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