DancEast Online Registration

Registration

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Welcome to the online registration system for DancEast Collective! Please provide your information below and then click Submit.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name and Cell Number*

Contact #1

Primary Contact First Name*

Last Name *

Type*

How Can We Contact You?

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from DancEast. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

(optional) Additional Contact First Name

Last Name

Type

How can we contact you?

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

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Additional Info

Student Email

Please let us know about special needs (i.e. physical limitations, allergies, sensory concerns).

Student's Preferred Pronouns

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Additional Info

Student Email

Please let us know about special needs (i.e. physical limitations, allergies, sensory concerns).

Student's Preferred Pronouns

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Additional Info

Student Email

Please let us know about special needs (i.e. physical limitations, allergies, sensory concerns).

Student's Preferred Pronouns

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Additional Info

Student Email

Please let us know about special needs (i.e. physical limitations, allergies, sensory concerns).

Student's Preferred Pronouns

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Additional Info

Student Email

Please let us know about special needs (i.e. physical limitations, allergies, sensory concerns).

Student's Preferred Pronouns

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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Registration

Family 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)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)