RockStar Academy of Dance Online Registration

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Welcome to RockStar Academy of Dance! We are so excited that you've decided to join us for our 19th Season! Please complete the following registration form and feel free to contact us with any questions or concerns!

* 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)

Health Insurance Carrier

Recital Policy Signed*

Media Policy Signed*

Liability Release Signed*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

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. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Participating in Recital? Y/N*

Rec classes: Please click on the Search button below, then choose the class.

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. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Participating in Recital? Y/N*

Rec classes: Please click on the Search button below, then choose the class.

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. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Participating in Recital? Y/N*

Rec classes: Please click on the Search button below, then choose the class.

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. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Participating in Recital? Y/N*

Rec classes: Please click on the Search button below, then choose the class.

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. By opting in, you agree to receive SMS messages from RockStar Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Participating in Recital? Y/N*

Rec classes: Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Plan option*

Membership Type

Please fill out ONE of the following Payment Methods

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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

Account Information

Required Policies

(Show-Hide Details)