Student's Name
*
First Name
Last Name
Student's Date of Birth
Applying to Enroll In
Kindergarten (4-day)
Kindergarten (2-day)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Firefly Friends (mom & tot)
Forest School (3-6)
Forest School (6-12)
Name of Parent/ Guardian #1
First Name
Last Name
Mailing Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
(###)
###
####
Email
Name of Parent/Guardian #2
First Name
Last Name
Mailing Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
How did you hear about Back to Earth School?
Current School, if applicable
Has your child attended any additional schools in the past five years? If so, please list below.
Tell us why you’re interested in Back to Earth School for your child. What draws you to our approach, and how do you see your child thriving here? If your child is transferring from another school, please share any context or reasons for the change.
*
Help us get to know your child. What is their personality like? What brings them joy? Tell us about their interests, strengths, challenges, and how they relate to others—whether with peers, siblings, adults, or in group settings. Feel free to share anything you feel is important for us to understand.
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Are there any concerns—past or present—regarding your child’s development or experience in school? This might include social, emotional, behavioral, academic, or physical challenges, as well as any disciplinary or learning difficulties in previous settings.
*
Does your child have any significant medical history we should be aware of? This may include diagnoses, surgeries, hospitalizations, therapies, or chronic conditions.
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Is there anything else you'd like to share with our team?