Step 1 of 5 – Family Information

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Family Information

Parent/Caregiver Name(Required)

First Last

Primary Phone Number(Required)

Primary Email Address(Required)

Additional Parent/Caregiver Name

First Last

Additional Parent/Caregiver Email

Additional Parent/Caregiver Phone

Children Attending

Please list all children who will be attending Roots (including infants or younger siblings who will be present).

Child(ren) attending(Required)

First Name

Last Name

Date of Birth

Would you like us to acknowledge your child’s birthday in a simple way during our time together?

Yes

Getting to Know Your Child(ren)

How would you describe your child(ren)’s temperament(s)?

What do they most enjoy right now? (play, activities, interests, rhythms)

What helps your child feel safe, settled, and connected?

Are there any current challenges or sensitivities you’d like us to be aware of?

Getting to Know You

Roots is as much for parents as it is for children.

What drew you to Roots?

How are you feeling in this season of parenting?

What kind of support, connection, or experience are you hoping for here?

Have you participated in a parent–child program before? If so, what did you enjoy or not enjoy about that experience?

Rhythm, Play, and Participation

In Roots, we focus on shared rhythms, open-ended play, and simple, meaningful activities. There is no pressure for children to perform or participate in a certain way—children are invited in through relationship and presence.

How does this approach feel for your family?

This approach feels aligned with our family

I’d like to learn more about this approach

Emotional Development & Support

In the early years, children are still growing the capacity to manage big feelings, transitions, and social experiences.

At Roots, we welcome this as part of healthy development. Our role is not to rush children past these experiences, but to support them through connection, presence, and relationship.

Our hope is to create a space where:

Children can express their feelings without shame
Parents feel supported and not alone
We can work together to support both you and your child

Supporting Your Child

How does your child typically express when they are overwhelmed, frustrated, or unsure?

What tends to help them feel safe or settled again?

Supporting You as a Parent

What tends to feel most challenging for you in this season of parenting?

When your child is having a hard moment, what support feels most helpful to you?

Partnering Together

Emotional expression comfort level

I feel comfortable allowing my child to express emotions while staying present with them

I would appreciate support and guidance in these moments

I’m not sure yet and would like to learn more

Open Communication

Communication comfort

I feel comfortable communicating openly if I’m feeling unsure, overwhelmed, or in need of support

I may need encouragement to reach out

Community & Communication

Roots is a shared space, and the tone of the environment is shaped by all of us together.

Are you comfortable communicating openly with the facilitator if questions or challenges arise?

Yes

Not at this time

Is there anything that would help you feel more comfortable or supported in this space?

Health & Considerations

Allergies or medical needs

Anything else we should be aware of to support your child(ren) safely and comfortably

Anything Else You’d Like to Share

Every family is unique.

Is there anything else you’d like us to know as we begin this time together?

Thank you for taking the time to share about your family. We read each response with care as we begin building a relationship with you. Our hope is that Roots feels like a place where both you and your child are supported, seen, and able to settle into a gentle rhythm together.