Carolyn Dutra Dance Studio Online Registration

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Thank you for choosing Carolyn Dutra Dance Studio! Once your enrollment for 2022-2023 season is approved, your primary card on file will be charged Registration+1st month Tuition. We process them manually so please allow a few days for your card to be processed. If you are just registering for a Summer class, no registration fee applies. See website for Covid Safety Policies, dress code and other Studio information.

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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*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Contact #1

Contact #1 First Name*

Last Name *

Relationship to Student*

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Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

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Contact #2

Contact #2 First Name

Last Name

Relationship to Student

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Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell # Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

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)

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.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell # Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

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)

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.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell # Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

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)

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.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell # Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

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)

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.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell # Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

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)

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.

Enroll in Classes

Select Class

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Account Information

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Credit Card

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Exp Year

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Address Line 2

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State

Zip

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