Portland Dance Center Online Registration

Registration

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* denotes required fields

Referral Information

How did you hear about us?*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Additional Info

Promo Code

Contact #1

Primary Contact First Name*

Last Name *

Relation*

How Can We Contact You?

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Secondary Contact First Name

Last Name

Relation

How can we contact you?

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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

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)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)