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RMA ROOST Registration 20-21

Please complete the form below. Required fields marked with an asterisk *

RMA Roost Pricing

5 day-a-week Pricing

Mornings only: $25
Afternoons only: $45
AM and PM: $55

Hybrid Pricing (2 Days) per week Pricing:

Mornings Only: $10
Afternoons Only: $18
AM and PM: $22

New Registration fee: $30

Before signing up, please be sure to review our Roost Terms and Conditions.

By checking the box below, you acknowledge that you've read and understand the Roost Terms and Conditions which are linked above.*

Answer required for "By checking the box below, you acknowledge that you've read and understand the Roost Terms and Conditions which are linked above."

Yes, I have reviewed and understand the Roost Terms and Conditions.

What RMA Roost service(s) are you enrolling in?*

Answer required for "What RMA Roost service(s) are you enrolling in?"

Which enrollment option have you selected?*

Answer required for "Which enrollment option have you selected?"

Student First Name*

Answer required for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

Child's Date of Birth*

Answer required for "Child's Date of Birth"

Primary Parent / Guardian First Name*

Answer required for "Primary Parent / Guardian First Name"

Primary Parent / Guardian Last Name*

Answer required for "Primary Parent / Guardian Last Name"

Mobile Phone*

Number Required

Home or Work Phone*

Number Required

Email Address of Parent / Guardian*

Answer required for "Email Address of Parent / Guardian"

Other Parent / Guardian First Name

Answer required for "Other Parent / Guardian First Name"

Other Parent / Guardian Last Name

Answer required for "Other Parent / Guardian Last Name"

Mobile Phone

Number Required

Home or Work Phone

Number Required

Email Address of Other Parent / Guardian

Answer required for "Email Address of Other Parent / Guardian"

Please list your emergency contacts and their contact information below. Number priority.*

1. Bob Smith, Father, 888-888-8888 2. Sara Smith, Aunt, 888-888-8881. 3. Joe Smith, etc.

Answer required for "Please list your emergency contacts and their contact information below. Number priority."

Does your child have a medical condition we should be aware of?*

If yes, please describe in the question below. If no, you may skip the next question.

Answer required for "Does your child have a medical condition we should be aware of?"

Yes

Please describe your child's medical condition(s)

Answer required for "Please describe your child's medical condition(s)"

BY SIGNING BELOW, I HEREBY AGREE TO ABIDE BY THE TERMS AND CONDITIONS OF THE PROGRAM AND FURTHER AGREE THAT ANY CHECK THAT IS RETURNED UNPAID, MAY BE RE-PRESENTED ELECTRONICALLY FOR PAYMENT, AND I AGREE THAT A SEPARATE ELECTRONIC DEBIT FROM THE ACCOUNT ON WHICH THE CHECK IS DRAWN MAY BE MADE FOR ANY SERVICE FEES ASSOCIATED WITH THE COLLECTION OF SUCH CHECK AS FURTHER DESCRIBED IN PARAGRAPH 7 OF THE TERMS AND CONDITIONS OF THE PROGRAM.

Please type your name below to acknowledge these terms and conditions.*

Answer required for "Please type your name below to acknowledge these terms and conditions."

How will you pay your 1st week & registration fee ($30)? (returning 7th and 8th graders do not need to repay the registration fee for the Roost if they were enrolled last year).*

Answer required for "How will you pay your 1st week & registration fee ($30)? (returning 7th and 8th graders do not need to repay the registration fee for the Roost if they were enrolled last year)."

Cash (drop-off to the office in a labeled envelope. EXACT CHANGE ONLY.

Check (may mail or drop-off in a labeled envelope, check payable to Rowlett Middle Academy).

Online at ezcaresoftware.com/parent-portal (Unavailable for new registrations).

Credit Card by Phone - 941-462-4001 ext. 1126. You may leave a message for Mrs. Rose.

*Payment and registration must be received to complete enrollment.

Will you be submitting a registration for another RMA student?*

If yes, please submit this form for each student.

Answer required for "Will you be submitting a registration for another RMA student?"

Yes

Would you like to utilize automatic payment for future charges? Please send your authorization form to the office, Attention Ms. Rose!

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"