Keiki Roots Enrollment Application

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Keiki Roots Enrollment Application | 2025–2026

Aloha and welcome! We're so happy you're considering Keiki Roots for your child (ages 5-11). Please complete this application for the 2026 Spring session. Our part-time program runs on Tuesday and Thursday, and Monday and Wednesday, from 9:00 AM – 2:00 PM. Parents and guardians are not required to stay on campus. We'll follow up with you soon after receiving your form. Mahalo!

Please select the two days you are applying for. *

Tuesday and Thursday

Monday and Wednesday

Required

If space is limited, would you be open to enrolling in either the Monday/Wednesday or Tuesday/Thursday option?
*

Yes, I’m open to being in Monday/Wednesday, Tuesday/Thursday, or Wednesday/Friday—whichever has availability.

No, we are only available for the dates we selected.

Child’s Full Name
*

Date of Birth
*

YYYY

Will your child be 5 years old or older by January 1, 2026?
*

Yes

Gender

Female

Male

Non-binary

Prefer not to say

Clear selection

Home Address

Primary Parent/Guardian Name *

Relationship to child

Phone Number *

Other Parent/Guardian (optional)

Relationship to Child
*

Email address *

Emergency Contact Name *

Emergency Contact Number *

Does your child have any medical conditions, allergies, or require any medications or special accommodations we should be aware of? If yes, please explain
*

Do you give permission for your child to be photographed for program-related use (e.g., newsletters, class activities, memories)?
*

Yes

Do you give permission for your child to participate in supervised walks and outdoor exploration near the campus?
*

Yes

Please review and check all boxes to confirm your understanding and agreement.

✅ I confirm that the information provided in this application is true and complete.

✅ I understand that this enrollment application differs from the contract and am not committing to any payments at this time.

✅ I understand that Keiki Roots is not a private school. We are a nature-based program designed to support homeschooling families with enriching, hands-on learning experiences in the natural world.

Other:

Required

Your name (as signature)

Date *

YYYY

$25- Please type "Paid" in the short answer text response, after you have paid

If you have a code for a waived application fee, type it into the short answer text response

Application Fee *

Submit

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