Carolyn Dutra Dance Studio Online Registration

Registration

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Thank you for choosing CDDS! Enrollment fees due upon enrollment (Registration Fee+September Tuition). After registering, go to billing & payments in your portal and submit payment. If not paid your primary card will be charged. No registration fee for Summer program. $15 decline fee.

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Referral Information

How did you hear about us?*

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 *

Relationship to Student*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

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

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Previous Dance School

Disabilities (Leave blank if NONE, do not write N/A)

Special Needs (Leave blank if NONE, do not write N/A)

Allergies (Leave blank if NONE, do not write N/A)

Medications (Leave blank if NONE, do not write N/A)

Prounounes

See website for class details. Age is used as a guideline for placement which is based on each students unique and individual capabilities determined by our graded curriculum.

Click Here for studio, class & dress code info.

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. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Previous Dance School

Disabilities (Leave blank if NONE, do not write N/A)

Special Needs (Leave blank if NONE, do not write N/A)

Allergies (Leave blank if NONE, do not write N/A)

Medications (Leave blank if NONE, do not write N/A)

Prounounes

See website for class details. Age is used as a guideline for placement which is based on each students unique and individual capabilities determined by our graded curriculum.

Click Here for studio, class & dress code info.

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. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Previous Dance School

Disabilities (Leave blank if NONE, do not write N/A)

Special Needs (Leave blank if NONE, do not write N/A)

Allergies (Leave blank if NONE, do not write N/A)

Medications (Leave blank if NONE, do not write N/A)

Prounounes

See website for class details. Age is used as a guideline for placement which is based on each students unique and individual capabilities determined by our graded curriculum.

Click Here for studio, class & dress code info.

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. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Previous Dance School

Disabilities (Leave blank if NONE, do not write N/A)

Special Needs (Leave blank if NONE, do not write N/A)

Allergies (Leave blank if NONE, do not write N/A)

Medications (Leave blank if NONE, do not write N/A)

Prounounes

See website for class details. Age is used as a guideline for placement which is based on each students unique and individual capabilities determined by our graded curriculum.

Click Here for studio, class & dress code info.

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. By opting in, you agree to receive SMS messages from Carolyn Dutra Dance Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Previous Dance School

Disabilities (Leave blank if NONE, do not write N/A)

Special Needs (Leave blank if NONE, do not write N/A)

Allergies (Leave blank if NONE, do not write N/A)

Medications (Leave blank if NONE, do not write N/A)

Prounounes

See website for class details. Age is used as a guideline for placement which is based on each students unique and individual capabilities determined by our graded curriculum.

Click Here for studio, class & dress code info.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

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*

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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

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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Questions or Concerns

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Credit Card

Required Policies

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