Mary Alice's Dance Studio Online 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

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Family Information

Family Last Name*

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Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Number*

Contact #1

Contact 1 First Name*

Last Name *

Type*

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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

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

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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*

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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

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

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