Student Application

Student Application

This is the general application to join The Roots of Music (ROM). Please only submit one application per student. You must complete a new form for siblings and multiple applicants. The requirements for admission are as follows: -Students must live/attend school in Orleans Parish. -Students must qualify for free or reduced school lunch. -Students must be aged 9-14 years.
Student Name *

First Name Middle Name Last Name
Student Address *

Street Address

Street Address Line 2

City State
Student's Gender's *

Male Female
Date Of Birth *

Month Day Year
Date
Student Ethnicity
Student Phone Number
Please enter a valid phone number.
Student Grade Level *
***At the time of Application
School Attending *
School Address *

Street Address

Street Address Line 2

City

Zip Code
School Released Time *

Hour Minutes

AM/PM Option
Student T-Shirt Size *
Parent/Guardian #1 Name *

First Name Last Name
Parent/Guardian #1 Email *
example@example.com
Parent/ Guardian #1 Phone Number *
Please enter a valid phone number.
Parent/ Guardian #2 Name

First Name Last Name
Parent/ Guardian #2 Email
example@example.com
Parent/ Guardian #2 Phone Number
Please enter a valid phone number.
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
Relationship to Student *
Please list any known medical conditions or ailments to consider regarding the applicant. If there are none to list, please type "N/A"*All ROM students are subject to physical activities that range from moderate to strenuous. We must be aware of any medical conditions or ailments that may require exclusion from certain activities. *
Does the applicant have any dietary restrictions? *
Which instrument does the applicant wish to learn? Chose TWO sections*Based on availability. ROM instructors reserve the right to place students where deemed appropriate. *

Upper Brass (Trumpet, Mellophone) Lower Brass (Trombone, Baritone Horn, Sousaphone/Tuba) Woodwind (Clarinet, Saxophone, Flute) Percussion (Drums & Cymbals)
The Roots of Music Inc. offers daily bus transportation at no cost to you. Please check any/all boxes that apply.Bus service is provided by a trusted third party contractor. Service may be limited to certain areas. Some restrictions may apply. *

This applicant requires bus service from his/her school to ROM during weekday programming (Mon-Thu). This applicant requires bus service from ROM to Home during weekday programming (Mon-Thu). This applicant requires bus service to and from ROM on the weekend (Sat). I will NOT require bus service for the applicant.
By submitting this application, the applicant is not guaranteed a spot in The Roots of Music. Once applications are submitted, they are reviewed by our staff. Parents/Guardians will be notified by a ROM representative, and given a date when the applicant may start attending the program. There will be documents for the parent/guardian to sign and return before the applicant is allowed to fully participate. *

"I have read the above text and agree."
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