Wild Roots Application
Thank you for your interest in Wild Roots Sept 2020 - June 2021 program in Santa Barbara / Goleta! The first step is to complete the application.

Once the application is received, it will be reviewed, the parent/s will be contacted, and a visit to the program will be arranged.

Please send the $25 application fee by Google Pay to wildroots.sb@gmail.com, or check by mail to Wild Roots, 3730 Avon Lane, Santa Barbara, CA 93105.

Wild Roots does not discriminate on the basis of gender, race, religion, or national origin in its admission policy or conduct of its educational programs.

Contact with questions: Kolmi Majumdar, Administrative Director, registrar.wildroots@gmail.com
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Gender *
Your answer
Ethnicity (optional)
Your answer
Program Interest *
Parent / Guardian First Name *
Your answer
Parent / Guardian Last Name *
Your answer
Your Email Address *
Your answer
Repeat Your Email address, so we're sure to have it right *
Your answer
Your Daytime Phone Number *
Your answer
Full Address (street, city, state, zip) *
Your answer
Occupation / Employer *
Your answer
Two-parent families: Please fill out the second parent/guardian information below.
2nd Parent / Guardian First Name
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2nd Parent / Guardian Last Name
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2nd Parent / Guardian Email
Your answer
2nd Parent / Guardian Phone Number
Your answer
Occupation / Employer
Your answer
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