Studio 109 Dance, Voice and Drama Online Registration

Registration

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Welcome to Studio 109 Dance, Voice & Drama. We are so happy you have decided to join us and become a 109er! Please fill in all fields below and when complete hit the submit registration button. The $25 registration fee is due upon registration. ($25 each student or $50 family). We DO NOT charge a registration fee for summer classes/intensive/camps. Payment is due upon registration.

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Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier

Enroll in auto pay?*

Auto pay for tuition only?*

Auto pay for all expenses?*

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

Who is your employer?

Employer

Employer Phone

Employer Notes

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

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

T-Shirt Size*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Authorize photos/videos?*

You will be required to have the proper dance shoe for each class. Outside shoes and socks are not permitted in any class.

Hair should be up in a neat bun at all times.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

T-Shirt Size*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Authorize photos/videos?*

You will be required to have the proper dance shoe for each class. Outside shoes and socks are not permitted in any class.

Hair should be up in a neat bun at all times.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

T-Shirt Size*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Authorize photos/videos?*

You will be required to have the proper dance shoe for each class. Outside shoes and socks are not permitted in any class.

Hair should be up in a neat bun at all times.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

T-Shirt Size*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Authorize photos/videos?*

You will be required to have the proper dance shoe for each class. Outside shoes and socks are not permitted in any class.

Hair should be up in a neat bun at all times.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

T-Shirt Size*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

Authorize photos/videos?*

You will be required to have the proper dance shoe for each class. Outside shoes and socks are not permitted in any class.

Hair should be up in a neat bun at all times.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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*

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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

Credit Card

Required Policies

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