Drama Kids of Rochester, NY Online Registration

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Welcome to Drama Kids of Rochester! Your payment will NOT be automatically processed when submitting your registration form. Your credit/debit card information will be STORED on our secure site. Your registration form will be reviewed in-house and prorating/discounts/payment plan options will be applied prior to processing your initial payment. Payments will be processed within 7 business days. Thank you again for choosing Drama Kids! The Difference is Dramatic!

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Other than parents) Name/Relationship/Phone*

Contact #1

Contact #1 First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email (Acting Academy only)

School*

Grade Level*

Health Conditions or Special Needs we should be aware of (Leave BLANK if none)

Allergies (Leave BLANK if none)

Medications we should be aware of (Leave BLANK if none)

Authorized Pick Up Names

Pick Up or After-Care Program*

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email (Acting Academy only)

School*

Grade Level*

Health Conditions or Special Needs we should be aware of (Leave BLANK if none)

Allergies (Leave BLANK if none)

Medications we should be aware of (Leave BLANK if none)

Authorized Pick Up Names

Pick Up or After-Care Program*

Enroll in Classes

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email (Acting Academy only)

School*

Grade Level*

Health Conditions or Special Needs we should be aware of (Leave BLANK if none)

Allergies (Leave BLANK if none)

Medications we should be aware of (Leave BLANK if none)

Authorized Pick Up Names

Pick Up or After-Care Program*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email (Acting Academy only)

School*

Grade Level*

Health Conditions or Special Needs we should be aware of (Leave BLANK if none)

Allergies (Leave BLANK if none)

Medications we should be aware of (Leave BLANK if none)

Authorized Pick Up Names

Pick Up or After-Care Program*

Enroll in Classes

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email (Acting Academy only)

School*

Grade Level*

Health Conditions or Special Needs we should be aware of (Leave BLANK if none)

Allergies (Leave BLANK if none)

Medications we should be aware of (Leave BLANK if none)

Authorized Pick Up Names

Pick Up or After-Care Program*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Plan (Will Default to Monthly Plan if Left Blank)*

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*

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)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

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Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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I Agree to All of the Above

Questions or Concerns

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Credit Card

Required Policies

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