AAP Dance, LLC Online Registration

Registration

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Welcome! We look forward to having you join our Summer Dance Intensive!

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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*

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

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 # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

School*

Grade Level*

Transportation*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Please register for the Summer Dance Intensive here. You may submit your donation via PayPal.me/aapdance or Zelle (aapdancellc@gmail.com) after your registration.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

School*

Grade Level*

Transportation*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Please register for the Summer Dance Intensive here. You may submit your donation via PayPal.me/aapdance or Zelle (aapdancellc@gmail.com) after your registration.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

School*

Grade Level*

Transportation*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Please register for the Summer Dance Intensive here. You may submit your donation via PayPal.me/aapdance or Zelle (aapdancellc@gmail.com) after your registration.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

School*

Grade Level*

Transportation*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Please register for the Summer Dance Intensive here. You may submit your donation via PayPal.me/aapdance or Zelle (aapdancellc@gmail.com) after your registration.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from AAP Dance, LLC. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

School*

Grade Level*

Transportation*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Please register for the Summer Dance Intensive here. You may submit your donation via PayPal.me/aapdance or Zelle (aapdancellc@gmail.com) after your registration.

Enroll in Classes

Select Class *

Add Another Student

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Questions or Concerns

Comments

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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)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

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Questions or Concerns

Required Policies

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