The Anna Marie Dance Studio Online Registration

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If you are a new family/student please contact the office at (302) 475-3949 or email us at AMDS.DE@gmail.com to discuss proper class placement. Please note that Anna Marie Dance Studio must approve each students class placement. If a student is enrolled in an inappropriate level AMDS will reach out to discuss alternative classes.

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Referral Information

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Referral Name

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*

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Email* (Emails are kept confidential)

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Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

Work #

Cell # Receive Text Message Notifications

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Confirm Email

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Employer

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

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Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

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Medications (Leave blank if NONE)

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

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T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Exp Month *

Exp Year *

Card Nickname

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Address Line 1

Address Line 2

City

State

Zip*

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Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

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Who is your employer?

Contact #2

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Who is your employer?

Student #1

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