Mary Alice's Dance Studio Online Registration

Registration

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Welcome to Mary Alice's Dance Studio Online Registration! Please feel free to browse our class listings and email us with any questions. Competition classes are not listed below. However, if you would like information about our competition team or company, please contact us at office@maryalices.com or 716 662 1080

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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*

Home or Primary Phone*

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

T-Shirt Size

Grade Level*

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

These classes are open to any student wishing to register at Mary Alice's Dance Studio.

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

Student Email

T-Shirt Size

Grade Level*

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

These classes are open to any student wishing to register at Mary Alice's Dance Studio.

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

Student Email

T-Shirt Size

Grade Level*

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

These classes are open to any student wishing to register at Mary Alice's Dance Studio.

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

Student Email

T-Shirt Size

Grade Level*

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

These classes are open to any student wishing to register at Mary Alice's Dance Studio.

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

Student Email

T-Shirt Size

Grade Level*

Disabilities (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

These classes are open to any student wishing to register at Mary Alice's Dance Studio.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

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Payment Information

I've read the above and agree.

Photo Release

I've read the above and agree.

Medical Emergency

I've read the above and agree.

Release of Liability

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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*

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)