Southern NH Dance Theater Online Registration

Registration

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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*

Disabilities*

Special Needs (Leave blank if NONE)

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*

Disabilities*

Special Needs (Leave blank if NONE)

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*

Disabilities*

Special Needs (Leave blank if NONE)

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*

Disabilities*

Special Needs (Leave blank if NONE)

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*

Disabilities*

Special Needs (Leave blank if NONE)

Allergies*

Medications*

How did you hear about us?*

Enroll in Classes

Select Class

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Required Policies and Agreements

Tuition Payment Terms & Conditions

ALL TUITION PAYMENTS ARE NON-REFUNDABLE. Tuition is payable by credit card and bank draft only. If tuition payment is denied or returned for insufficient funds, additional fees may apply. If tuition payment is denied by your financial institution, you may be asked to forfeit your child's place in the program. Any and all cancellations or withdrawals require a 30-day notification and account holders signature to receive an SNHDT account credit and are subject to a cancellation fee. Refunds are not given for classes missed or unattended.