Coomer Ballet Conservatory Online Registration

Registration

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Welcome to Coomer Ballet Conservatory! Registration fees are $55 for the first student and $25 for each additional due annually at the time of Fall Registration. We require a 30-day written notice to drop any classes. ***Dancers must be enrolled by November to participate in our Spring Recital.

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Health Insurance Carrier Name, Policy #, Group ID, Insurance Phone #

Contact #1

Contact #1 First Name*

Last Name *

Type

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Home Phone *

Work #

Cell # *

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Email* (Emails are kept confidential)

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Portal Account Password

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Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

Work #

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Coomer Ballet Conservatory. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

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Please fill out CREDIT CARD Payment Method

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Questions or Concerns

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Required Policies

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