Kathy Blake Dance Studios Online Registration

Registration

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Online registration requires a credit card and email address. Charges will be posted to your credit card after your registration has been reviewed and discounts applied, if applicable. You will then be notified by email within 24-48 hours of the receipt and charges. If you have questions before registering, please call/text the studio at 603-673-3978 or send an email with questions to kbdsinfo@gmail.com.

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Referral Information

How did you hear about us?*

Referral Name*

Family/Adult Student's Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Parent/Adult Student First Name*

Last Name *

Type*

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

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Grade Level*

Disabilities to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher IE: Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Grade Level*

Disabilities to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher IE: Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Grade Level*

Disabilities to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher IE: Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Grade Level*

Disabilities to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher IE: Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Grade Level*

Disabilities to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher IE: Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

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*

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Registration

Referral Information

Family/Adult Student's Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

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

Required Policies

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