Faberge Follies Online Registration

Registration

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Welcome to Faberge Follies! This is a secure website. Please fill out the information below. This form must be signed by the student's PARENT (if student is under age 18).

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Student Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name & Phone Number*

Health Insurance Carrier*

Why did you choose Faberge?

Contact #1

Parent First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Allergies*

Medications*

Primary Doctor*

Have you danced before?

If yes, where and how long?

What are your dance goals?

Please select the class you want to take. If unsure contact Miss Faberge 570-454-1418. She'll help you choose. When you come to your first class, you'll be evaluated to be sure you've made the ideal selection. Miss Faberge must approve of your placement. ----- Or, if you don't want to select a class right now, just skip to the next step.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Allergies*

Medications*

Primary Doctor*

Have you danced before?

If yes, where and how long?

What are your dance goals?

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Allergies*

Medications*

Primary Doctor*

Have you danced before?

If yes, where and how long?

What are your dance goals?

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Allergies*

Medications*

Primary Doctor*

Have you danced before?

If yes, where and how long?

What are your dance goals?

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Allergies*

Medications*

Primary Doctor*

Have you danced before?

If yes, where and how long?

What are your dance goals?

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

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

Required Policies

(Show-Hide Details)