Southside Form

Rooted Registration Fall 2026

Registrant Information

Campus*

Name*

First Name*

Last Name*

Email Address*

Phone Number

Address*

Address Line 1*

Address Line 2

City*

State*

Zip*

Date of Birth*

Gender*

Are You Registering a Spouse?*

Yes No

Spouse Information

Spouse Name*

First Name*

Last Name*

Spouse Phone Number*

Spouse Email Address*

Spouse Date of Birth*

Spouse Gender*

Child Care

Let us know if you'll need childcare during Rooted. Childcare is only offered for 5th grade and below.

Will you need childcare during Rooted?*

Yes No

How many children will need childcare?

Please list names and ages of children

Example: Emma - 4, Noah - 2

Placement Information

These answers help us place you in the best possible group.

Life Stage*

Group Preference*

Anything else we should know when placing you in a Rooted group?

Acknowledgements

Please confirm you understand how registration and placement works.*

I understand this registration will be reviewed before final group placement. Preferences will be used to aid group placement, but are not guaranteed by default.

Payment Option

Pay in full