Barclay Shelton Dance Centre Online Registration

Registration

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Welcome to Barclay Shelton’s online dance registration!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Your Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 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

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

IMPORTANT:

You will be registering your dancer onto a waitlist, not enrolling directly into the class.

If you are signing up for more than one waitlist for the same level, please note in the comments box your preferred day and time.
You will receive confirmation of class enrollment via an email containing your dancer’s schedule for our summer session within 3 business days.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

IMPORTANT:

You will be registering your dancer onto a waitlist, not enrolling directly into the class.

If you are signing up for more than one waitlist for the same level, please note in the comments box your preferred day and time.
You will receive confirmation of class enrollment via an email containing your dancer’s schedule for our summer session within 3 business days.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

IMPORTANT:

You will be registering your dancer onto a waitlist, not enrolling directly into the class.

If you are signing up for more than one waitlist for the same level, please note in the comments box your preferred day and time.
You will receive confirmation of class enrollment via an email containing your dancer’s schedule for our summer session within 3 business days.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

IMPORTANT:

You will be registering your dancer onto a waitlist, not enrolling directly into the class.

If you are signing up for more than one waitlist for the same level, please note in the comments box your preferred day and time.
You will receive confirmation of class enrollment via an email containing your dancer’s schedule for our summer session within 3 business days.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

IMPORTANT:

You will be registering your dancer onto a waitlist, not enrolling directly into the class.

If you are signing up for more than one waitlist for the same level, please note in the comments box your preferred day and time.
You will receive confirmation of class enrollment via an email containing your dancer’s schedule for our summer session within 3 business days.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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Registration

Referral Information

Your 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?

Who is your employer?

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

Credit Card

Required Policies

(Show-Hide Details)