Carolyn Dutra Dance Studio Online Registration

Registration

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Thank you for choosing Carolyn Dutra Dance Studio! Enrollment fees due upon enrollment(Registration+1st month Tuition ). If not submitted it will be charged by Studio manually. No registration fee for Summer classes/camps and session classes. Parents drop off/pick up students. Studio doors are locked while classes are in session for safety reasons.

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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

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

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

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.

Click Here for first day of class instructions.

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

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.

Click Here for first day of class instructions.

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

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.

Click Here for first day of class instructions.

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

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.

Click Here for first day of class instructions.

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

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.

Click Here for first day of class instructions.

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

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Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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