St. Croix Valley Dance Academy Online Registration

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Thank you for registering for classes at SCVDA. We are happy to help you in any way possible!

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Referral Information

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Family Information

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Home Address*

City*

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Zip*

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Contact #1

Primary Contact First Name*

Last Name *

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Contact #2

Emergency Contact First Name*

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Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from St. Croix Valley Dance Academy. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

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Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

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Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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Student #2 (Show-Hide Details)

Student's First Name*

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Student #4 (Show-Hide Details)

Student's First Name*

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Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

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Student Gender

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Additional Info

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Medications (Leave blank if NONE)

Enroll in Classes

Select Class *

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Exp Month

Exp Year

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Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

Referral Information

Family Information

Where do you live?

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

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

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Required Policies

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