Centre Stage School of Dance Online Registration

Registration

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Welcome to Centre Stage School of Dance! Please complete the entire form. Our classes are categorized by ages. Please select the appropriate class based on your child's age by October 31st. It is especially important that you include an EMAIL ADDRESS and form of payment

* denotes required fields

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

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Centre Stage School of Dance. 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

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

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

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Previous Dance School

Dance years

Previous Dance School

Dance years

All Saturday dance classes are Combo classes which include: Ballet, Pointe (if selected), Tap, Jazz, Modern, Lyrical and Creative Movement for our little ones. All Weekday dance classes are discipline specific: Acro, Twirling.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Previous Dance School

Dance years

Previous Dance School

Dance years

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Previous Dance School

Dance years

Previous Dance School

Dance years

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Previous Dance School

Dance years

Previous Dance School

Dance years

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Previous Dance School

Dance years

Previous Dance School

Dance years

Enroll in Classes

Select Class *

Add Another Student

Required Policies

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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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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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

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)