Deep Root Center Distance Learning Membership Form
The Deep Root Center Distance Learning Membership form includes Personal Info, Membership Contract and Release, Expectations and Recommendations, the DRC Community Agreement, and the table of membership levels. Children in one family can share a membership. If you plan on choosing that option, be sure to choose the level that will give them the number of hours they wish to participate virtually. Please fill out a separate membership form if your children will not be sharing a membership. We look forward to working with your family!

If you have any questions, please contact maria@deeprootcenter.org.
How many children in your family will be participating in the DRC Distance Learning Program? *
If more than one child is participating, will they be sharing a membership? *
Child's Name *
2nd Child's Name (if sharing)
3rd Child's Name (if Sharing)
Child's DOB *
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2nd Child's DOB
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3rd Child's DOB
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Parent or Guardian Name(s) *
Email *
Address *
School District *
Cell Phone 1 *
Cell Phone 2
What attracts you most to DRC?
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