Studio `91 Online Registration

Registration

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Online registration requires a credit card & email address. No charges will be posted to your card until your enrollment has been reviewed. You will then be notified by email within 7 to 10 business days of payment receipt detailing charges. We look forward to having you dance with us! If you cannot supply this information or have questions before registering, please call the studio at 717.691.5567 or email questions to janice@studio91.com

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Studio `91 Dance Family Information

Family: Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

Contact #1

Parent/Guardian Name 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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent/Guardian #2 Name First Name

Last Name

Type

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*

Birth Date*

Cell #

Additional Info

Dancer Email

School District*

Grade Level*

Disabilities (leave blank if None)

Allergies (leave blank if None)

Medications (leave blank if None)

Primary Doctor

Class are subject to change due to demand and interest. Staff instructors will teach classes, unless otherwise noted. A minimum number of students must be registered in order to run the class. A decision will be made two weeks prior to the first day of class. You will be notified if the class is cancelled and your tuition will be refunded.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Dancer Email

School District*

Grade Level*

Disabilities (leave blank if None)

Allergies (leave blank if None)

Medications (leave blank if None)

Primary Doctor

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Dancer Email

School District*

Grade Level*

Disabilities (leave blank if None)

Allergies (leave blank if None)

Medications (leave blank if None)

Primary Doctor

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Dancer Email

School District*

Grade Level*

Disabilities (leave blank if None)

Allergies (leave blank if None)

Medications (leave blank if None)

Primary Doctor

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Dancer Email

School District*

Grade Level*

Disabilities (leave blank if None)

Allergies (leave blank if None)

Medications (leave blank if None)

Primary Doctor

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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Registration

Referral Information

Studio `91 Dance 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

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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