Kerri's Dance Studio Online Registration

Registration

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Kerri's Dance Studio 2021-2022

* 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*

Home or Primary Phone*

Additional Info

Contact #1

Parent First Name*

Last Name *

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* (format=mm/dd/yyyy)

Cell #

Additional Info

Special Needs (Leave blank if NONE)

There is a $25.00 single student registration fee due at this time. There is an additional $5.00 registration fee for each additional student.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Special Needs (Leave blank if NONE)

There is a $25.00 single student registration fee due at this time. There is an additional $5.00 registration fee for each additional student.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Special Needs (Leave blank if NONE)

There is a $25.00 single student registration fee due at this time. There is an additional $5.00 registration fee for each additional student.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Special Needs (Leave blank if NONE)

There is a $25.00 single student registration fee due at this time. There is an additional $5.00 registration fee for each additional student.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Special Needs (Leave blank if NONE)

There is a $25.00 single student registration fee due at this time. There is an additional $5.00 registration fee for each additional student.

Enroll in Classes

Select Class

Add Another Student