Studio de danse Danielle Online Registration

Registration

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Merci d'avoir choisi le Studio de danse Danielle! SVP fournir l'information suivante pour les COURS et les CAMPS. Vous pourrez ensuite effectuer votre choix de cours/camp. Au plaisir de vous rencontrer bientot........................................... Thank you for choosing Studio de Danse Danielle! Please provide the information below for CLASSES and CAMPS. You will then be able to choose the class/camp. We look forward to meeting you soon.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Parents

Nom de famille de l'enfant/Child's Surname Last Name*

Where do you live?

Home Address*

City*

State/Prov*

Postal Code*

Home or Primary Phone*

Contact #1

Parent # 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

Parent # 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)

Additional Info

Difficultes/Disabilites

Allergies (Leave blank if NONE)

Veuillez vous assurer de choisir le bon emplacement (Aylmer/Plateau/Online). Si nous devons modifier votre inscription, nous entrerons en contact avec vous dans les plus brefs delais. Please ensure you choose the appropriate location (Aylmer/Plateau/Online). If we need to modify your registration, we will contact you as soon as possible.

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student