Chehalem Valley Dance Academy Online Registration

Student #1

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

Medications (Leave blank if NONE)

Primary Doctor

All classes above beginning are by placement only. Please visit iheartcvda.com/free-trial to book a free trial for placement. Company classes are for those dancers in the group only. Adult classes can also include teens with permission from instructor.

Tuition is calculated by total hours per dancer. We will review registrations and notify you of any changes that need to be made. Our tuition info and policies, dress code, and all other important info is on our website at iheartvda.com.

Thank you so much for enrolling at CVDA!

Newberg Location Address 311 E 1st, Newberg, OR 97132

McMinnville Location Address 826 SE 1st St, McMinnville, OR 97128 (in the Boho Building)

West Salem Location Address 1363 Edgewater St NW, Salem OR 97304

-CVDA Team

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

Medications (Leave blank if NONE)

Primary Doctor

All classes above beginning are by placement only. Please visit iheartcvda.com/free-trial to book a free trial for placement. Company classes are for those dancers in the group only. Adult classes can also include teens with permission from instructor.

Tuition is calculated by total hours per dancer. We will review registrations and notify you of any changes that need to be made. Our tuition info and policies, dress code, and all other important info is on our website at iheartvda.com.

Thank you so much for enrolling at CVDA!

Newberg Location Address 311 E 1st, Newberg, OR 97132

McMinnville Location Address 826 SE 1st St, McMinnville, OR 97128 (in the Boho Building)

West Salem Location Address 1363 Edgewater St NW, Salem OR 97304

-CVDA Team

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

Medications (Leave blank if NONE)

Primary Doctor

All classes above beginning are by placement only. Please visit iheartcvda.com/free-trial to book a free trial for placement. Company classes are for those dancers in the group only. Adult classes can also include teens with permission from instructor.

Tuition is calculated by total hours per dancer. We will review registrations and notify you of any changes that need to be made. Our tuition info and policies, dress code, and all other important info is on our website at iheartvda.com.

Thank you so much for enrolling at CVDA!

Newberg Location Address 311 E 1st, Newberg, OR 97132

McMinnville Location Address 826 SE 1st St, McMinnville, OR 97128 (in the Boho Building)

West Salem Location Address 1363 Edgewater St NW, Salem OR 97304

-CVDA Team

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

Medications (Leave blank if NONE)

Primary Doctor

All classes above beginning are by placement only. Please visit iheartcvda.com/free-trial to book a free trial for placement. Company classes are for those dancers in the group only. Adult classes can also include teens with permission from instructor.

Tuition is calculated by total hours per dancer. We will review registrations and notify you of any changes that need to be made. Our tuition info and policies, dress code, and all other important info is on our website at iheartvda.com.

Thank you so much for enrolling at CVDA!

Newberg Location Address 311 E 1st, Newberg, OR 97132

McMinnville Location Address 826 SE 1st St, McMinnville, OR 97128 (in the Boho Building)

West Salem Location Address 1363 Edgewater St NW, Salem OR 97304

-CVDA Team

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

Medications (Leave blank if NONE)

Primary Doctor

All classes above beginning are by placement only. Please visit iheartcvda.com/free-trial to book a free trial for placement. Company classes are for those dancers in the group only. Adult classes can also include teens with permission from instructor.

Tuition is calculated by total hours per dancer. We will review registrations and notify you of any changes that need to be made. Our tuition info and policies, dress code, and all other important info is on our website at iheartvda.com.

Thank you so much for enrolling at CVDA!

Newberg Location Address 311 E 1st, Newberg, OR 97132

McMinnville Location Address 826 SE 1st St, McMinnville, OR 97128 (in the Boho Building)

West Salem Location Address 1363 Edgewater St NW, Salem OR 97304

-CVDA Team

Enroll in Classes

Select Class

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

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Portal Access (your email is your login)

Contact #2

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Student #1

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Questions or Concerns

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eCheck/Bank Draft

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

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

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