Just Dance! Online Registration

Registration

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Welcome to Just Dance online registration! Please enter your information below and click submit when complete. Your credit card will be charged at this time. Class discounts will be calculated at time of credit card charges

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Tuition

Tuition is due by the 1st of each month. A $10 late fee will be charged and
applied to tuition not paid by the 10th of each month.We accept Visa and Mastercard as well as checks. Accounts can be set up for automatic tuition payments from your credit card or checking account. students with tuition not paid will not be allowed to participate in class until all past due fees are paid. There will be a $35 charge for any returned checks, Fees will not be credited or prorated for missed classes ,holidays or closings. .Make up classes are available.
all fees are non refundable