Heidi Knight School of Dance Online Registration

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Welcome to Heidi Knight School of Dance!

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Referral Information

How did you hear about us?*

Referral Name

Account Information

Account Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Person responsible for payment*

Contact #1

Contact #1 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

Work #

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*

Grade*

Special Needs (Leave blank if NONE)

Allergies, etc. that we need to be aware of

Years at HKSD INCLUDING 23-24 *

Please read the class requirements/descriptions carefully. If you don't see the "register" or "wait list" option, that means the class and wait list are full. Please email our office if you'd like to be notified if another class option opens up.

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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*

Grade*

Special Needs (Leave blank if NONE)

Allergies, etc. that we need to be aware of

Years at HKSD INCLUDING 23-24 *

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*

Grade*

Special Needs (Leave blank if NONE)

Allergies, etc. that we need to be aware of

Years at HKSD INCLUDING 23-24 *

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*

Grade*

Special Needs (Leave blank if NONE)

Allergies, etc. that we need to be aware of

Years at HKSD INCLUDING 23-24 *

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*

Grade*

Special Needs (Leave blank if NONE)

Allergies, etc. that we need to be aware of

Years at HKSD INCLUDING 23-24 *

Enroll in Classes

Select Class

Add Another Student

Required Policies

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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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Referral Information

Account 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

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Student #3 (Show-Hide Details)

Additional Info

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Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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Payment Information

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