Carolyn Dutra Dance Studio Online Registration

Registration

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Thank you for choosing CDDS! Enrollment fees (Registration Fee + September Tuition) are due at registration. Submit payment through your portal after enrolling. Unpaid enrollments will be charged to the primary card on file and dropped if payment is unsuccessful. No Registration Fee for Summer Programs. $15 decline fee applies. Tuition auto pay is required with a valid credit card on file. No refunds.

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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 # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Carolyn Dutra Dance Studio. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

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 #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Carolyn Dutra Dance Studio. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

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

Age is a guideline, placement is based on each student's individual abilities and progress within our graded curriculum.

Click Here for studio info, class details and dress code requirements.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Age is a guideline, placement is based on each student's individual abilities and progress within our graded curriculum.

Click Here for studio info, class details and dress code requirements.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Age is a guideline, placement is based on each student's individual abilities and progress within our graded curriculum.

Click Here for studio info, class details and dress code requirements.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Age is a guideline, placement is based on each student's individual abilities and progress within our graded curriculum.

Click Here for studio info, class details and dress code requirements.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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

Age is a guideline, placement is based on each student's individual abilities and progress within our graded curriculum.

Click Here for studio info, class details and dress code requirements.

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 #3 (Show-Hide Details)

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