Registration
Already a customer? Click here to login.
*
denotes required fields
Referral Information
How did you hear about us?
Annual Dance Show
Facebook / Facebook Ad
Instagram
Other
Referral Name
Family Information
Family Last Name
*
Where do you live?
Home Address
*
City
*
State
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip
*
Primary Phone
*
Additional Info
Emergency Contact Info
*
Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Aunt
Brother
Emergency
Father
Gaurdian
Grandparent
Mother
Other
Parent
Self
Sister
Sister-in-Law
Spouse
Uncle
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
Type
Aunt
Brother
Emergency
Father
Gaurdian
Grandparent
Mother
Other
Parent
Self
Sister
Sister-in-Law
Spouse
Uncle
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
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
School
Grade Level
*
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
college
kindergarten
preschool
Allergies (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
School
Grade Level
*
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
college
kindergarten
preschool
Allergies (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
School
Grade Level
*
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
college
kindergarten
preschool
Allergies (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
School
Grade Level
*
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
college
kindergarten
preschool
Allergies (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Cell #
Additional Info
Student Email
School
Grade Level
*
10th
11th
12th
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Adult
college
kindergarten
preschool
Allergies (Leave blank if NONE)
Add Another Student
Required Policies
(Show-Hide Details)
I Agree to All of the Above
Enter your Full Name
*
November 21, 2024
Questions or Concerns
Comments
Payment Information
Credit Card
Card Number
*
Visa
Mastercard
Discover
Exp Month
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year
*
Card Nickname
Name as it appears on card
*
Address Line 1
Address Line 2
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip
*
Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios
,
gyms
,
swim schools
,
music schools
,
cheer gyms
,
childcare centers
, and
more
.
