Huntington Academy of Dance Online Registration

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Welcome to Huntington Academy of Dance! We are so happy to have your join our HAD community of families! If you have questions, need help with registration, or more info, please call our friendly office staff at (714) 847-6657 or email info@had4dance.com To register, please complete the information below and click submit. You can start dancing with us immediately on Facebook, Instagram, and YouTube @had4dance We look forward to seeing you in the studio soon! Happy Dancing!

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Referral Information

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Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell #

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Huntington Academy of Dance. 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

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

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

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Choose any filter to begin viewing available classes.

Enroll in Classes

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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 Huntington Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Choose any filter to begin viewing available classes.

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 Huntington Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Choose any filter to begin viewing available classes.

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 Huntington Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Choose any filter to begin viewing available classes.

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 Huntington Academy of Dance. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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

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

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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)

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