Dance Institute of Washington Online Registration

Registration

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Welcome to The Dance Institute of Washington's online registration! **The $25.00 Registration fee must be paid for the registration form to be submitted** BIENVENDIO al Instituto de Danza de Washington linea de registro! Favor de completar la información inferior. **El costo de $25.00 de Inscripcion se tienen que pagar antes de someter la aplicacion de matricula**

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Referral Information

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Demographic Information

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Home Address*

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Additional Info

Emergency Contact Info (name, address, email, number, relationship)*

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Contact #1

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Work # *

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Confirm Email*

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Contact #2

2nd Parent/Guardian First Name

Last Name

Relationship*

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Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender (Identify as)*

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

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Who will pick up the student with ID? Add students name if 16 years or older.*

Physical Needs (i.e. elevators, leave blank if none)

Non-Physical Needs (i.e. emotional, behavioral, leave blank if none)

Dietary Needs (i.e. food allergies, vegetarian, leave blank if none)

Medical Needs (i.e. meds given at home, emergency meds like EpiPen, leave blank if none))

Primary Doctor

Prior Training (if none please write "none")*

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Black/African American?

Other?

Pant size?*

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender (Identify as)*

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

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Who will pick up the student with ID? Add students name if 16 years or older.*

Physical Needs (i.e. elevators, leave blank if none)

Non-Physical Needs (i.e. emotional, behavioral, leave blank if none)

Dietary Needs (i.e. food allergies, vegetarian, leave blank if none)

Medical Needs (i.e. meds given at home, emergency meds like EpiPen, leave blank if none))

Primary Doctor

Prior Training (if none please write "none")*

Free/Reduced Lunch?*

Hispanic/Latino?

Black/African American?

Other?

Pant size?*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender (Identify as)*

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

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Who will pick up the student with ID? Add students name if 16 years or older.*

Physical Needs (i.e. elevators, leave blank if none)

Non-Physical Needs (i.e. emotional, behavioral, leave blank if none)

Dietary Needs (i.e. food allergies, vegetarian, leave blank if none)

Medical Needs (i.e. meds given at home, emergency meds like EpiPen, leave blank if none))

Primary Doctor

Prior Training (if none please write "none")*

Free/Reduced Lunch?*

Hispanic/Latino?

Black/African American?

Other?

Pant size?*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender (Identify as)*

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

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Who will pick up the student with ID? Add students name if 16 years or older.*

Physical Needs (i.e. elevators, leave blank if none)

Non-Physical Needs (i.e. emotional, behavioral, leave blank if none)

Dietary Needs (i.e. food allergies, vegetarian, leave blank if none)

Medical Needs (i.e. meds given at home, emergency meds like EpiPen, leave blank if none))

Primary Doctor

Prior Training (if none please write "none")*

Free/Reduced Lunch?*

Hispanic/Latino?

Black/African American?

Other?

Pant size?*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender (Identify as)*

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

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Who will pick up the student with ID? Add students name if 16 years or older.*

Physical Needs (i.e. elevators, leave blank if none)

Non-Physical Needs (i.e. emotional, behavioral, leave blank if none)

Dietary Needs (i.e. food allergies, vegetarian, leave blank if none)

Medical Needs (i.e. meds given at home, emergency meds like EpiPen, leave blank if none))

Primary Doctor

Prior Training (if none please write "none")*

Free/Reduced Lunch?*

Hispanic/Latino?

Black/African American?

Other?

Pant size?*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

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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*

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Registration

Referral Information

Demographic 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?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Additional Info

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Required Policies

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