The Rooted Space Online Registration

Registration

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Welcome to The Rooted Space! We are so excited to have your Sprouts join us this session! Please complete the following registration form. All Contact Info should be yours, and student info should be your child/children.

* 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?

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*

Please click on the Search button below, then choose the class you would like to enroll your child or children in

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Please click on the Search button below, then choose the class you would like to enroll your child or children in

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Please click on the Search button below, then choose the class you would like to enroll your child or children in

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Please click on the Search button below, then choose the class you would like to enroll your child or children in

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Please click on the Search button below, then choose the class you would like to enroll your child or children in

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

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Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Enroll in Classes

Student #2 (Show-Hide Details)

Enroll in Classes

Student #3 (Show-Hide Details)

Enroll in Classes

Student #4 (Show-Hide Details)

Enroll in Classes

Student #5 (Show-Hide Details)

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Required Policies

(Show-Hide Details)