Machita Dance Company Online Registration

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Nurturing Life Skills For Life Lessons Welcome to Machita Dance Company! We are committed to fostering our students’ growth by teaching them proper dance technique, teamwork, and the value of hard work. Our goal is to help them build confidence and develop as individuals, all while having fun and forming lasting friendships in a positive and nurturing environment.

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Home Address*

City*

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Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

Why did you choose MDC*

Contact #1

Contact #1 First Name*

Last Name *

Type*

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Cell # * Receive Text Message Notifications

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Student #1

Student's First Name*

Last Name*

Student Gender*

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Additional Info

Student Email

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School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Medications (Leave blank if NONE)

Primary Doctor*

Dancer's Cell Phone

Total Years of Dance*

Total Years of Dance with MDC*

T-Shirt Size*

Scheduling conflicts

Our classes are based on levels. If you are unsure of your placement contact our office and we will help guide you .

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

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Dancer's Cell Phone

Total Years of Dance*

Total Years of Dance with MDC*

T-Shirt Size*

Scheduling conflicts

Our classes are based on levels. If you are unsure of your placement contact our office and we will help guide you .

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

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Dancer's Cell Phone

Total Years of Dance*

Total Years of Dance with MDC*

T-Shirt Size*

Scheduling conflicts

Our classes are based on levels. If you are unsure of your placement contact our office and we will help guide you .

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

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Dancer's Cell Phone

Total Years of Dance*

Total Years of Dance with MDC*

T-Shirt Size*

Scheduling conflicts

Our classes are based on levels. If you are unsure of your placement contact our office and we will help guide you .

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

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Dancer's Cell Phone

Total Years of Dance*

Total Years of Dance with MDC*

T-Shirt Size*

Scheduling conflicts

Our classes are based on levels. If you are unsure of your placement contact our office and we will help guide you .

Enroll in Classes

Select Class

Add Another Student

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Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

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