Please note: Payment details are required to secure all trial classes and enrolments with Dance Republic however no payment will be processed until your enrolment is reviewed by Administration &/or you have confirmed that you would like to continue with classes after your trial All Term 1, 2019 enrolments require 1 x month tuition to be paid to secure registration (January payment). The first monthly direct debit cycle will be on the 1st February 2019.

*   denotes required fields

Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Who is your employer?
Contact #2
How can we contact you?
(Emails are kept confidential)
Who is your employer?
Student #1
Additional Info
Enroll in Classes
Select Class *
Required Policies and Agreements
I Agree to All of the Above
Questions or Concerns
Payment Information
Please fill out ONE of the following Payment Methods
Credit Card
eCheck/Bank Draft
(Your name on your bank statement)
(6-digit number)