Northern Plains Dance Online Registration

Registration

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Enrollment at Northern Plains Dance (NPD) requires a $25 annual registration fee per family (not required for Adult, On the Go!, Camps, or waitlisted classes). Accounts will be automatically charged when reviewed by NPD. Any discounts or class adjustments will be assessed during payment processing. Default pricing is for the 4-Installment payment plan per semester. NPD is a 501(c)(3) nonprofit organization and all information collected is kept 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*

ND*

Zip*

Primary Phone*

Additional Info

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

Relationship to Student

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? *

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies(Leave blank if NONE)

Medications (Leave blank if NONE)

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? *

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies(Leave blank if NONE)

Medications (Leave blank if NONE)

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? *

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies(Leave blank if NONE)

Medications (Leave blank if NONE)

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? *

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies(Leave blank if NONE)

Medications (Leave blank if NONE)

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? *

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies(Leave blank if NONE)

Medications (Leave blank if NONE)

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

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Questions or Concerns

Comments

Payment Information

Account Information

Payment Plan Selection*

Please fill out ONE of the following Payment Methods

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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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I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Required Policies

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