Northern Plains Dance Online Registration

Registration

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Submit this form to request placement; NPD will contact you to confirm classes. Tuition may be paid in 2, 4 or 9 installments. 2 and 4 installment plans include a slight discount on tuition. We encourage you to select the Auto payment option. Please contact us if you have any questions. NOTE: NPD collects basic demographic information including # of people in household and income for federal grant purposes only. This information will be kept anonymous and confidential.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family (Student) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name & Number (*Must be other than Parent/Guardian. )*

Number of People in Household

Parent/Guardian Employer(s)*

Enter Promo Code

Contact #1

Parent/Guardian 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

Parent/Guardian 2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Student Email

School*

Academic Grade*

Would you like a locker rental for $60/school year? *

Does your child have a current or past diagnosis that may impact participation in class?

Does your child have any severe allergies we should be made aware of? (Leave blank if NONE)

Does your child currently take medications that may impact their participation in dance?

Please select a class by clicking the button below. You will see a list of classes available to you. If you have questions, email dance@northernplainsdance.org or call 701.530.0986.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Student Email

School*

Academic Grade*

Would you like a locker rental for $60/school year? *

Does your child have a current or past diagnosis that may impact participation in class?

Does your child have any severe allergies we should be made aware of? (Leave blank if NONE)

Does your child currently take medications that may impact their participation in dance?

Please select a class by clicking the button below. You will see a list of classes available to you. If you have questions, email dance@northernplainsdance.org or call 701.530.0986.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Student Email

School*

Academic Grade*

Would you like a locker rental for $60/school year? *

Does your child have a current or past diagnosis that may impact participation in class?

Does your child have any severe allergies we should be made aware of? (Leave blank if NONE)

Does your child currently take medications that may impact their participation in dance?

Please select a class by clicking the button below. You will see a list of classes available to you. If you have questions, email dance@northernplainsdance.org or call 701.530.0986.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Student Email

School*

Academic Grade*

Would you like a locker rental for $60/school year? *

Does your child have a current or past diagnosis that may impact participation in class?

Does your child have any severe allergies we should be made aware of? (Leave blank if NONE)

Does your child currently take medications that may impact their participation in dance?

Please select a class by clicking the button below. You will see a list of classes available to you. If you have questions, email dance@northernplainsdance.org or call 701.530.0986.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

Student Email

School*

Academic Grade*

Would you like a locker rental for $60/school year? *

Does your child have a current or past diagnosis that may impact participation in class?

Does your child have any severe allergies we should be made aware of? (Leave blank if NONE)

Does your child currently take medications that may impact their participation in dance?

Please select a class by clicking the button below. You will see a list of classes available to you. If you have questions, email dance@northernplainsdance.org or call 701.530.0986.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Total Household Income*

Please select a payment schedule.*

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)

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

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

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