Connectivity Dance Online Registration

Registration

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Welcome to Connectivity Dance! Please provide your information below and click SUBMIT when complete. All enrolments are considered pending until your registration has been reviewed and approved. All fees will automatically post once registration for a class or event has been submitted. Discounts will be manually adjusted by administration. Please ensure the policies have been signed to complete your registration. We are excited to have you for our 16th season in Leduc

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Primary Phone*

Additional Info

Emergency Contact Info (Please enter someone other than Primary Contact)*

Alberta Health Care#

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

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*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Class Accommodations Needed (Leave blank if NONE)

Medical Info Relevant to Participation*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Training

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Class Accommodations Needed (Leave blank if NONE)

Medical Info Relevant to Participation*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Training

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Class Accommodations Needed (Leave blank if NONE)

Medical Info Relevant to Participation*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Training

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Class Accommodations Needed (Leave blank if NONE)

Medical Info Relevant to Participation*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Training

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Class Accommodations Needed (Leave blank if NONE)

Medical Info Relevant to Participation*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Training

Enroll in Classes

Select Class

Add Another Student

Required Policies

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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)

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)

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Questions or Concerns

Required Policies

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