Student Application - The Roots of Music
This is the general application to join the Roots of Music (ROM). Please only submit one application per student. For siblings and/or multiple applicants, you must complete a new form. The requirements for admission are as follows:
-Students must be aged 9-14 years.
-Students must live/attend school in Orleans Parish.
-Students must qualify for free or reduced school lunch.
* Required
1a. Last Name-Student
*
Do not include suffix (Jr, III, etc)
Your answer
1b. First Name-Student
*
Your answer
1c.Middle Name-Student
Your answer
1d. Suffix
e.g. Jr., II, IV, etc.
Choose
Jr.
II
III
IV
V
2. Date of Birth-Student
*
MM
/
DD
/
YYYY
3. Gender-Student
*
Boy
Girl
5. Ethnicity-Student
Choose
Black/African American
Native American
Hispanic/Latin American
Asian/Pacific Islander
White
Other
Student Phone Number
Your answer
4. Student grade level at the time of application
*
Choose
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
6. What school is your child attending?
*
Your answer
7. What is the address of your child's school?
Your answer
8. What is the main phone number of your child's school?
Your answer
9. What time does the applicant's school dismiss?
*
please answer in this format: 4:05p
Your answer
10a. Home Address-Student
*
Only the number and street name.
Your answer
10b. Home Address-Student (Line 2)
If there is an apartment or unit number.
Your answer
10c. City
*
Your answer
10d. State
Your answer
10e. Zip Code
Your answer
11. T-shirt Size-Student
Please use the shirt size of the student at the time of application.
Choose
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Adult 4Xl
12. Parent/Guardian #1 Name
*
Your answer
12a. Relationship with student?
*
Choose
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other*
12b. *If you answered [other] to question 12a, please describe your relationship with the applicant?
e.g. Legal Guardian; Brother/Sister, etc.
Your answer
12c. Parent/Guardian #1 Home Phone Number
please include area code
Your answer
12d. Parent/Guardian #1 Cell Phone Number
*
please include area code
Your answer
12e. Parent/Guardian #1 Other Phone Number
please include area code
Your answer
12f. Parent/Guardian #1 email address
*
Your answer
13. Parent/Guardian #2 Name
Your answer
13a. Relationship with student?
Choose
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Other*
13b. *If you answered [other] to question 13a, please describe your relationship with the applicant?
e.g. Legal Guardian; Brother/Sister, etc.
Your answer
13c. Parent/Guardian #2 Home Phone Number
please include area code
Your answer
13d. Parent/Guardian #2 Cell Phone Number
*
please include area code
Your answer
13e. Parent/Guardian #2 Other Phone Number
please include area code
Your answer
13f. Parent/Guardian #2 email address
Your answer
14. Emergency Contact Person #1 Name
*
In case parent/guardian can not be reached in the event of an emergency.
Your answer
14a. Relationship to Student
*
Your answer
14b. Emergency Contact Person #1 Phone Number
*
please include area code
Your answer
15. Emergency Contact Person #2 Name
In case parent/guardian can not be reached in the event of an emergency.
Your answer
15a. Relationship to Student
Your answer
15b. Emergency Contact #2 Phone Number
please include area code
Your answer
16. 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. It is important that we are aware of any medical conditions, or ailments that may require exclusion from certain activities.
Your answer
16a. Please list any physical limitations. If there are none to list please type "N/A"
*
All ROM students are subject to physical activities that range from moderate to strenuous. It is important that we are aware of any limitations that your child may have in order to accommodate.
Your answer
17. Does the applicant have any dietary restrictions?
*
No Food Restrictions
Vegetarian
Vegan
Gluten-Free
Food Allergies (Please list in next question)
Required
18. Please list any known allergies.
*
This is including but not limited to allergies to certain medication, food allergies, and/or plant/insect allergies. If there are no known allergies to list, please type "N/A."
Your answer
19. 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)
Required
20. 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.
I will NOT require bus service for the applicant.
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).
Required
20. Does the applicant receive free, or reduced lunch at his/her school?
*
Yes, the applicant recieves free/reduced lunch.
No, the applicant does not receive free/reduced lunch.
Required
21. Does the applicant have any social, emotional, or behavioral needs that should be brought to the attention of ROM staff?
Some ROM students have BIPs, IEPs, and 504 classifications. We take pride in serving the needs of ALL of our students. Please request a private meeting if you would like to discuss any considerations that the applicant may require. Please trust that care is taken to maintain confidentiality regarding all applicants/students.
Yes. Please have someone from your staff contact me for a private conference.
No. No accommodations are needed.
22. If there is any other information that you would like to be considered in this application, please provide it below.
Your answer
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."
Required
Submit
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