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 2024 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*

Additional Info

Student Email

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, please click the "SELECT CLASS" button below to make a selection. (trials start in September 2024 for classes with open spots)

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Additional Info

Student Email

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, please click the "SELECT CLASS" button below to make a selection. (trials start in September 2024 for classes with open spots)

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Additional Info

Student Email

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, please click the "SELECT CLASS" button below to make a selection. (trials start in September 2024 for classes with open spots)

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Additional Info

Student Email

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, please click the "SELECT CLASS" button below to make a selection. (trials start in September 2024 for classes with open spots)

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student*

Birth Date*

Additional Info

Student Email

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, please click the "SELECT CLASS" button below to make a selection. (trials start in September 2024 for classes with open 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)