5678 Dance Studio Inc Online Registration

Registration

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Thank you for joining 5678 Dance Studio. We look forward to teaching your child to "Dance the Dream". August tuition and registration fee will be automatically charged on August 1st. This payment will hold your child's spot in the class. If payment is not made on or before your child's 1st class your child will be dropped from that class. Annual tuition is based on 11 months of classes per season, August 2024 through June 2025.

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Referral Information

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Home Address*

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Zip*

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Additional Info

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Contact #1

Contact #1 First Name*

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Work # *

Cell # *

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Contact #2

Contact #2 First Name

Last Name

Type

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)*

Please note that the credit card you submitted during registration is not automatically charged until the 1st of each month.

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)*

Please note that the credit card you submitted during registration is not automatically charged until the 1st of each month.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)*

Please note that the credit card you submitted during registration is not automatically charged until the 1st of each month.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)*

Please note that the credit card you submitted during registration is not automatically charged until the 1st of each month.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)*

Please note that the credit card you submitted during registration is not automatically charged until the 1st of each month.

Enroll in Classes

Select Class *

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Address Line 1

Address Line 2

City

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Zip*

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

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Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

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