North Shore Dance Academy Online Registration

Registration

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Welcome to North Shore Dance Academy. Thank you for your interest in our school.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Cell # *

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?

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Classes are sectioned by genre and age. Please choose the class that fits your child's age as of September 1st.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Classes are sectioned by genre and age. Please choose the class that fits your child's age as of September 1st.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Classes are sectioned by genre and age. Please choose the class that fits your child's age as of September 1st.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Classes are sectioned by genre and age. Please choose the class that fits your child's age as of September 1st.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Classes are sectioned by genre and age. Please choose the class that fits your child's age as of September 1st.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)