Southern NH Dance Theater Online Registration

Registration

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* 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*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Parent/Guardian #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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent/Guardian #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*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites*

Special Needs

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites*

Special Needs

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites*

Special Needs

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites*

Special Needs

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites*

Special Needs

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Registration Fee

An annual $25.00 ($45.00 maximum per family) registration fee is automatically charged to all new registrations for classes that meet September to June. This fee is only charged once in a calendar year. This fee is non-refundable.