Haven Dance Academy Online Registration

Registration

Already a customer? Click here to login.

Please note: This form is for new customers only. If you have previously registered, you may log in to the customer portal to register for additional classes or to add another student. Please contact us if you need assistance or have any questions at info@havendanceacademy.com

* 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*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Work #

Cell #

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

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email (if applicable)

Allergies (Leave blank if NONE)

Please feel free to contact us at info@havendanceacademy.com or 425.678.2800 if you have any questions about class placement and we will be more than happy to help assist you.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email (if applicable)

Allergies (Leave blank if NONE)

Please feel free to contact us at info@havendanceacademy.com or 425.678.2800 if you have any questions about class placement and we will be more than happy to help assist you.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email (if applicable)

Allergies (Leave blank if NONE)

Please feel free to contact us at info@havendanceacademy.com or 425.678.2800 if you have any questions about class placement and we will be more than happy to help assist you.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email (if applicable)

Allergies (Leave blank if NONE)

Please feel free to contact us at info@havendanceacademy.com or 425.678.2800 if you have any questions about class placement and we will be more than happy to help assist you.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email (if applicable)

Allergies (Leave blank if NONE)

Please feel free to contact us at info@havendanceacademy.com or 425.678.2800 if you have any questions about class placement and we will be more than happy to help assist you.

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?

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

Credit Card

Required Policies

(Show-Hide Details)