Anastasis dba Radiance School of Ballet Online Registration

Registration

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Welcome to Radiance School of Ballet! We are excited to have you enrolled in our school, and we hope it brings you great joy as you embark on, or continue on, your journey in dance education. Our goal is to provide you with the highest quality training and dance education in a nurturing, challenging and encouraging environment. Please complete the following registration form to secure yourself and/or your child's spot in their classes.

* 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 (Not Contact #1 or #2)*

Adult Ballet-class card (Y/N)?*

If Y, choose 8,10,15 or 20hrs

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Cell # *

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 #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Select Class button below, then choose the class(es) you would like to enroll yourself and/or child in.

Do note the Tuition rates are per month for the duration of the session. Please view our Policies for further detail on studio processes.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Select Class button below, then choose the class(es) you would like to enroll yourself and/or child in.

Do note the Tuition rates are per month for the duration of the session. Please view our Policies for further detail on studio processes.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Select Class button below, then choose the class(es) you would like to enroll yourself and/or child in.

Do note the Tuition rates are per month for the duration of the session. Please view our Policies for further detail on studio processes.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Select Class button below, then choose the class(es) you would like to enroll yourself and/or child in.

Do note the Tuition rates are per month for the duration of the session. Please view our Policies for further detail on studio processes.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Student Email

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please click on the Select Class button below, then choose the class(es) you would like to enroll yourself and/or child in.

Do note the Tuition rates are per month for the duration of the session. Please view our Policies for further detail on studio processes.

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)

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)