Nolte Academy of Dance Online Registration

Registration

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Welcome to the Nolte Academy and Open Doors Dance Festival registration! Whether you're a beginner or an experienced performer, you're in the right place. Please complete the online registration form for your family. Please note our online system does not accept credit cards and will require banking information. If you wish to use a credit card for automatic payment, please call or stop in to our studio. Questions? Contact us at frontdesk@nolteacademy.com or 319-688-9289.

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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

Physician

Prefer Automatic ACH on (Y/N)*

Prefer Automatic CC (Y/N)*

Prefer Walk In Payment (Y/N)*

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites

Special Needs

Allergies

Medications

Skill Notes*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Tuition and Fees

By checking this box I agree that if I enroll in Nolte Academy's 2018-2019 program(s), a non-refundable registration fee per student is due at the time of registration and will be automatically debited from my bank account or credit card on file. Monthly class fees are due on the 1st day of month via cash, check or credit card. Any unpaid fees after the 1st day will be automatically deducted from my billing preferences.