Consultation Request Form
This form is for families who are thinking of removing a child from the public school system. The professionals at Deep Root Center are here to listen and help. We will be in touch within 24 hours of receiving this form.
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Child(ren)'s Preferred Name(s)
Child(ren)'s's DOB *
Child's Grade Level *
Parent or Guardian Name(s) *
Parent Email *
Mailing Address *
School District *
Cell Phone 1 *
Why are you seeking our help? (check as many as apply) *
Which service are you interested in learning about?
Where did you hear about DRC? *
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