Birmingham Dance Theatre Online Registration

Registration

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A Registration Fee will be charged to the account you have on file when you submit your Registration Form. Please make sure you have read and agree with ALL studio policies, including the 30-day written drop notice and NON-WAIVED fees upon dropping.

* denotes required fields

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*

Health Insurance Carrier*

Occupation?*

Contact #1

Parent/Guardian #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Birmingham Dance Theatre. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

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 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 # By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Birmingham Dance Theatre. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

T-shirt Size*

Recital or No Recital?

OFFICE PERSONNEL CANNOT PLACE ANY STUDENT IN A CLASS. Students class placement must be approved by the Faculty during Registration Consultation Days. If you are registering ON LINE, you may only register with a recommendation from the Placement coordinator. RETURNING STUDENTS must have approval from the BDT Teacher who is teaching the designated class if not registering for their approved placement.

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*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

T-shirt Size*

Recital or No Recital?

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*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

T-shirt Size*

Recital or No Recital?

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*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

T-shirt Size*

Recital or No Recital?

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*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

T-shirt Size*

Recital or No Recital?

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 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

(Show-Hide Details)