Encore Performers Online Registration

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THANK YOU FOR REGISTERING FOR CLASSES AT ENCORE PERFORMERS! If you are a current student, please use the link above "Already a customer? Click here to login." Payment will be made separately following registration via email invoice. Please notify us at encoreperformers@gmail.com if you do not receive it.

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Referral Information

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Referral Name

FAMILY INFORMATION

FAMILY LAST Last Name*

Where do you live?

Home Address*

City*

State*

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Primary Phone*

Contact #1

PARENT #1 First Name*

Last Name *

Type

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Home Phone *

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

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Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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Student #3 (Show-Hide Details)

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Student Gender*

Birth Date*

Additional Info

Student Email

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Student #4 (Show-Hide Details)

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Additional Info

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Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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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

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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