City of Rockville Dept of Recreation and Parks Automated Registration System
Family Registration Information Form


Submit your family registration information online using this form to become part of the City of Rockville's automated registration system: Rock Enroll. Instructions will be emailed to you within 1-2 business days on how to retrieve your Family Account Number and Personal ID number. These numbers will give you access to your Rock Enroll account for registration to our City programs. If you need to update your account please email the information to rockenroll@rockvillemd.gov The information you provide is for registration purposes only and will be kept confidential.



All fields marked with are required for new enrollments

Adult/Parent
Adult Parent Last Name:
First Name:
Gender:
Date of Birth (mm/dd/yyyy):
Work Phone Number:
Home Phone Number:
Street Address:
City and State:
ZIP Code:
E-mail:

Second Adult/Parent
Adult/Parent - Last Name:
First Name:
Gender:
Date of Birth (mm/dd/yyyy):
Work Phone Number:
Home Phone Number:
Street Address:
City and State:
ZIP Code:
E-mail:

Emergency Contact (other than parent)
Emergency Contact - Last Name:
First Name:
Phone Number:

Children in the Family Household

Child One
Last Name:
First Name:
Date of Birth (mm/dd/yyyy):
Gender:
School Attending:
Current Grade 2013-2014 School Year:

Child Two
Last Name:
First Name:
Date of Birth (mm/dd/yyyy):
Gender:
School Attending:
Current Grade 2013 -2014 School Year:

Child Three
Last Name:
First Name:
Date of Birth (mm/dd/yyyy):
Gender:
School Attending:
Current Grade 2013 -2014 School Year:

Child Four
Last Name:
First Name:
Date of Birth (mm/dd/yyyy):
Gender:
School Attending:
CCurrent Grade 2013 -2014 School Year:
Comments: