Portland Dance Center Online Registration

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Referral Information

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Family Information

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Home Address*

City*

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Zip*

Additional Info

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Contact #1

Primary Contact First Name*

Last Name *

Relation*

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Cell # * Receive Text Message Notifications

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Confirm Email*

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Contact #2

Secondary Contact First Name

Last Name

Relation

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Cell # * Receive Text Message Notifications

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

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Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Please choose a class below! If your desired class is full, please select the 'waitlist' option, and we will notify you as soon as a spot opens.

Enroll in Classes

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Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

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Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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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

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