WILD Enrollment Form

WILD Enrollment Form
Student Information
Student 1 Legal Name

First NameMiddle NameLast Name
Student 1 Preferred Name / Nickname
Student 1 Date of Birth

MonthDayYear
Date
Student 1 Grade
Student 1 Gender / Sex

Other
Student 1 Primary Language Spoken at Home
Student 1 Federal Ethnicity and Race

Other
Student 1 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 2 Legal Name

First NameMiddle NameLast Name
Student 2 Preferred Name / Nickname
Student 2 Date of Birth

MonthDayYear
Date
Student 2 Grade
Student 2 Gender / Sex

Other
Student 2 Primary Language Spoken at Home
Student 2 Federal Ethnicity and Race

Other
Student 2 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 3 Legal Name

First NameMiddle NameLast Name
Student 3 Preferred Name / Nickname
Student 3 Date of Birth

MonthDayYear
Date
Student 3 Grade
Student 3 Gender / Sex

Other
Student 3 Primary Language Spoken at Home
Student 3 Federal Ethnicity and Race

Other
Student 3 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 4 Legal Name

First NameMiddle NameLast Name
Student 4 Preferred Name / Nickname
Student 4 Date of Birth

MonthDayYear
Date
Student 4 Grade
Student 4 Gender / Sex

Other
Student 4 Primary Language Spoken at Home
Student 4 Federal Ethnicity and Race

Other
Student 4 Additional Ethnicity / Race Details
Household & Address
Household Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is this address temporary, a shared housing, a shelter, a hotel, a campground, a vehicle, or an abandoned building?
Mailing Address (if different)
Previous School
Most Recent School Attended
Last Date Attended

MonthDayYear
Date
School Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
School Address, City, and State
Has Your Student Been Enrolled Elsewhere This School Year (2026-2027)
Reason for Transfer/Enrollment in WILD
Parent/Guardian Information
Parent/Guardian 1 Full Name

First NameMiddle NameLast Name
Parent/Guardian 1 Relationship to Student
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 1 Preferred Language
Parent/Guardian 1 Cell / Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Mailing Address if Different
Parent/Guardian 1 Lives with Student
Parent/Guardian 1 Has Legal Authority for Educational Decisions
Additional Parent/Guardian 1 Contact Notes
Is there an additional Parent/Guardian?
Parent/Guardian 2 Full Name

First NameMiddle NameLast Name
Parent/Guardian 2 Relationship to Student
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Preferred Language
Parent/Guardian 2 Cell/Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Mailing Address if Different
Parent/Guardian 2 Lives with Student
Parent/Guardian 2 Has Legal Authority for Educational Decisions (if answer is No, please provide court documents)
Additional Parent/Guardian 2 Contact Notes
Emergency Contacts 1 & 2
Emergency Contact 1 Name

First NameLast Name
Emergency Contact 1 Relationship
Emergency Contact 1 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Relationship
Emergency Contact 2 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Services/Supports/Legal/Medical
If "Yes" is selected with any of these items, we will reach out to visit with you for more information and to arrange for services and documentation.
Special education services
Section 504 Plan
English Learner services
Custody restrictions or court orders
Medical, allergy, or safety concerns
Needs, supports, or concerns
Home Learning Environment
Reliable internet at home
Needs help securing internet (minimal financial assistance is available)
Has a device for learning
Requests a district device
Has a camera and microphone to video conference (Phone, tablet, computer)
Has a quiet learning space
Has adult support available during learning time
May need help with organization or time management
Primary device used for learning
Other device
Internet provider or type
Average internet reliability
Best times for check-ins
Program Expectations & Student Profile
Student interests, hobbies, strengths, and career goals
What type of projects or real-world learning would motivate your student(s)?
What do you hope for you student in our WILD program?
Do you foresee your students needing assistance with any of the following?

Other
Permissions & Communication
May WILD staff communicate with the student through school-approved email, learning platforms, and video conferencing?
May WILD display student work in school exhibitions, websites, presentations, or community showcases without sharing sensitive student information?
May WILD use your student(s) photo or video as part of our school communication, website, social media, or prublications
What are your preferred methods of communication? (select all that apply)

Other
Required Documents Checklist (box to upload is below)
Birth Certificate
Immunization Records
Proof of Residency
Transcript or Report Card
IEP / Evaluation / Special Education Documents
Other Documents
File Upload

Cancelof
Signatures
By signing I understand WILD is a public school program with attendance, participation, progress, and communication expectations.
By signing I understand the student will participate in virtual instruction, teacher check-ins/touchpoints, feedback and revision cycles, and project-based learning experiences.
By signing I understand WILD is not simply a packet or independent homeschool option; the studentmust stay engaged with teachers, coursework, projects, and required assessments.
By signing I understand parent/guardian support is important and that a learning coach or adult should help the student maintain routines, workspace, communication, and progress.
By signing I understand the student may be required to attend in-person testing, orientation, exhibitions, field experiences, or other school-sponsored activities when scheduled. (minimal if ever)
By signing I understand the school will communicate concerns about attendance, progress, missingwork, or lack of engagement, and families are expected to respond in a timely manner.
By signing I understand the student must follow district technology, acceptable use, academichonesty, behavior, and student safety expectations while enrolled in WILD.
By signing I certify that the information provided in this enrollment form is accurate to the best of my knowledge. I understand that additional documentation may be required to complete enrollment and that WILD staff my contact me for clarification or support planning.
Parent/Guardian 1 Printed Name
Date

MonthDayYear
Date
Signature
Parent/Guardian 2 Printed Name
Date

MonthDayYear
Date
Signature
Should be Empty:

WILD Enrollment Form

Student Information

Household & Address

Previous School

Parent/Guardian Information

Emergency Contacts 1 & 2

Services/Supports/Legal/Medical

If "Yes" is selected with any of these items, we will reach out to visit with you for more information and to arrange for services and documentation.

Home Learning Environment

Program Expectations & Student Profile

Permissions & Communication

Required Documents Checklist (box to upload is below)

Signatures