Wonder Roots LLC Online Registration

Registration

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Welcome!
Steps to enroll:

1. Please complete and submit the following registration form.
2. Sign in to the customer portal to process your payment and complete your enrollment.
**Enrolling in a free class? No worries! You will NOT be charged.**

Note: Adult Students enrolling in our parent or educator workshops/events will need to add themselves as a Contact (choose Type: Self) AND as a Student to enroll in a class.
Thank you

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Enrollment Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Grade Level or ADULT

Disabilities we should know about? (Leave blank if NONE)

Special Needs or Accommodations needed for program participation? (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Student Pronouns

Dietary Restrictions?

Choose your class below. You may also add additional classes or students.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Grade Level or ADULT

Disabilities we should know about? (Leave blank if NONE)

Special Needs or Accommodations needed for program participation? (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Student Pronouns

Dietary Restrictions?

Choose your class below. You may also add additional classes or students.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Grade Level or ADULT

Disabilities we should know about? (Leave blank if NONE)

Special Needs or Accommodations needed for program participation? (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Student Pronouns

Dietary Restrictions?

Choose your class below. You may also add additional classes or students.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Grade Level or ADULT

Disabilities we should know about? (Leave blank if NONE)

Special Needs or Accommodations needed for program participation? (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Student Pronouns

Dietary Restrictions?

Choose your class below. You may also add additional classes or students.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Grade Level or ADULT

Disabilities we should know about? (Leave blank if NONE)

Special Needs or Accommodations needed for program participation? (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Student Pronouns

Dietary Restrictions?

Choose your class below. You may also add additional classes or students.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

Referral Information

Enrollment Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

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

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)