WEBBY Dance Company - Dayton Online Registration

Registration

Already a customer? Click here to login.

WEBBY Dance Company will be offering fun & exciting Virtual Dance and Creative Movement classes launched weekly on Wednesdays! Stay active with us with videos that can be viewed at your convenience! - Your card is NOT automatically charged upon registration, our office will process your card after receiving your enrollment! - Please email HMatteson@webbydancecompany.com with any questions!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Student's Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

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 # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please select our Online Weekly Class subscription listing! Tuition is heavily discounted at $24.00 per family, per month. Enrollment is ongoing. - Our office will charge your card on file for $24.00 for the first month's tuition after we receive your enrollment! - Monthly tuition, beyond your first month, will be processed on the 1st of each month. Weekly Online Class Video Links & Passwords will be emailed each Wednesday morning!

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Liability Release

I've read the above and agree.

Text Messaging Updates

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

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*

Registration

Referral Information

Family Information

Where do you live?

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 and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)