All That Jazz Dance Studio Online Registration

Registration

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Welcome to All That Jazz Dance Studio! 60 minute classes are $985.00. 45 minute classes are $750.00. Multiple class discounts applied automatically. Registration requires a bank routing number, account number, and email. Total tuition fee will be deducted from your bank account after your registration has been approved. Any questions about registration or potential payment plans, please call Miss Deb at 617-641-0784 or email missdeb@allthatjazznewton.com.

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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 Info (Not Contact #1 or #2)

Contact #1

Name First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Type First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Preferred Pronouns

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher; e.g., Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Medications (Leave blank if NONE)

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Preferred Pronouns

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher; e.g., Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Medications (Leave blank if NONE)

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Preferred Pronouns

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher; e.g., Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Medications (Leave blank if NONE)

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Preferred Pronouns

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher; e.g., Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Medications (Leave blank if NONE)

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Preferred Pronouns

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites to inform teacher

Special Needs to inform teacher

Medical conditions to inform teacher; e.g., Asthma, Peanut Allergy, Diabetes, Hearing Impaired

Medications (Leave blank if NONE)

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

eCheck/Bank Draft

Bank Name *

Account Type *

Your Account Name * (Your name on your bank statement)

Bank Routing Number * (9-digit number)

Account Number *

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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

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I Agree to All of the Above

Questions or Concerns

Payment Information

eCheck/Bank Draft

Required Policies

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