Registration

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IMPORTANT: 1PM DANCE You are signing up for the 1PM DANCE If you are already a member of our dance family, please click above to log in to the Parent Portal to register for the event. Thank you. PLEASE NOTE: **Your Card on file will be charged after your enrollment for the dance is completed.**

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info*

Students entered below will be added to your family's account

Questions/Options:


Will you be bringing an additional sibling for $15?*
List names of all child/children attending.*
List attending adults name*

Additional Information:

Enter your Full Name:

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*

eCheck/Bank Draft:

Bank Name:

Bank Routing Number:

(9-digit number)

Your Account Name:

(Your name on your bank statement)

Your Account Type:

Account Number: