Interplay Dance Online Registration

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Welcome to PSB & Interplay Dance Academy and thank you for joining our school.

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Referral Information

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Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Primary Phone*

Additional Info

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

Enter Coupon #*

Contact #1

Contact #1 First Name*

Last Name *

Type*

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Contact #2

Contact #2 First Name

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Confirm Email

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Employer

Employer Phone

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Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Participating in recital*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

Immunizations YN

Immunization Notes

Thank you for joining our school! Please see our web site for you or your child's dress code: psb-interplay-dance.ca/registration.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Participating in recital*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

Immunizations YN

Immunization Notes

Thank you for joining our school! Please see our web site for you or your child's dress code: psb-interplay-dance.ca/registration.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Participating in recital*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

Immunizations YN

Immunization Notes

Thank you for joining our school! Please see our web site for you or your child's dress code: psb-interplay-dance.ca/registration.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Participating in recital*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

Immunizations YN

Immunization Notes

Thank you for joining our school! Please see our web site for you or your child's dress code: psb-interplay-dance.ca/registration.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Participating in recital*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

Immunizations YN

Immunization Notes

Thank you for joining our school! Please see our web site for you or your child's dress code: psb-interplay-dance.ca/registration.

Enroll in Classes

Select Class

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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

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