Registration
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You have registered for the Peewee Hip Hop Camp Waitlist. If a spot opens for this camp, we will reach out to see if you still want this spot. No charge is made until you let us know that you want the spot.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
Step-Dad
Step-parent
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
kindergarten
preschool
toddler
Allergies:
Medications (Leave blank if NONE):
Previous ROOTS Dancer?:
*
Current ROOTS Music Student?:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
kindergarten
preschool
toddler
Allergies:
Medications (Leave blank if NONE):
Previous ROOTS Dancer?:
*
Current ROOTS Music Student?:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
kindergarten
preschool
toddler
Allergies:
Medications (Leave blank if NONE):
Previous ROOTS Dancer?:
*
Current ROOTS Music Student?:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
kindergarten
preschool
toddler
Allergies:
Medications (Leave blank if NONE):
Previous ROOTS Dancer?:
*
Current ROOTS Music Student?:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
kindergarten
preschool
toddler
Allergies:
Medications (Leave blank if NONE):
Previous ROOTS Dancer?:
*
Current ROOTS Music Student?:
*
Additional Information:
Waitlist policy
(Show-Hide Details)
I understand that I am currently on the waitlist for Peewee Hip Hop Camp, and do not have a spot secured to participate in camp. In the event a spot becomes available, I will be contacted at that time and given 48 hours to accept the spot and complete registration including payment in full ($299) to secure my student's spot at camp.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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