ROOTS Academy Online Registration

Registration

Already a customer? Click here to login.

To enroll, please fill out the form below.

Note: A credit card is required to register for all classes.
Trial registration starts in September for classes with open spots. If you are registering for a free trial class, your card will not be charged.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Previous ROOTS Dancer?*

Current ROOTS Music Student?*

To enroll in a class or register for a trial, click the “SELECT CLASS” button below and choose your desired class. Trial registration opens in September for classes with available spots.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Previous ROOTS Dancer?*

Current ROOTS Music Student?*

To enroll in a class or register for a trial, click the “SELECT CLASS” button below and choose your desired class. Trial registration opens in September for classes with available spots.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Previous ROOTS Dancer?*

Current ROOTS Music Student?*

To enroll in a class or register for a trial, click the “SELECT CLASS” button below and choose your desired class. Trial registration opens in September for classes with available spots.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Previous ROOTS Dancer?*

Current ROOTS Music Student?*

To enroll in a class or register for a trial, click the “SELECT CLASS” button below and choose your desired class. Trial registration opens in September for classes with available spots.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Previous ROOTS Dancer?*

Current ROOTS Music Student?*

To enroll in a class or register for a trial, click the “SELECT CLASS” button below and choose your desired class. Trial registration opens in September for classes with available spots.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios , gyms , swim schools , music schools , cheer gyms , childcare centers , and more .

Registration

To enroll, please fill out the form below.

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)