Ultimate Dance Center Online Registration

Registration

Already a customer? Click here to login.

Welcome to the Ultimate Dance Center!

* 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*

Primary Phone*

Additional Info

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

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

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

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Ultimate Dance Center. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios , gyms , swim schools , music schools , cheer gyms , childcare centers , and more .

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)

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 (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)