Dance Institute of Washington Online 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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Contact #1

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Student #1

Student's First Name*

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Additional Info

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Name of Current School*

Current Grade Level*

Who will dismiss the student with proof of identity? Add students name if 16 years or older. *

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

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

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender (Identify as)*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Name of Current School*

Current Grade Level*

Who will dismiss the student with proof of identity? Add students name if 16 years or older. *

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

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

Dietary Restrictions (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

Covid Vaccination?*

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

Name of Current School*

Current Grade Level*

Who will dismiss the student with proof of identity? Add students name if 16 years or older. *

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

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

Dietary Restrictions (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

Covid Vaccination?*

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

Name of Current School*

Current Grade Level*

Who will dismiss the student with proof of identity? Add students name if 16 years or older. *

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

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

Dietary Restrictions (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

Covid Vaccination?*

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

Name of Current School*

Current Grade Level*

Who will dismiss the student with proof of identity? Add students name if 16 years or older. *

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

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

Dietary Restrictions (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

Covid Vaccination?*

Free/Reduced Lunch?*

Hispanic/Latino?*

Black/African American?*

Other?*

Pant size?*

Enroll in Classes

Select Class

Add Another Student

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Exp Year *

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Name as it appears on card *

Address Line 1

Address Line 2

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Referral Information

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Contact #1

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Contact #2

How can we contact you?

Student #1

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