Nine Ladies Dancing Online Registration

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Welcome to Nine Ladies Dancing-Dance Academy! We are so glad you found us!

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

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

Contact #1

Contact #1 First Name*

Last Name *

Type

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Home Phone

Work #

Cell # * Receive Text Message Notifications

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Email* (Emails are kept confidential)

Confirm Email*

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Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Nine Ladies Dancing Handbook.jpg

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Nine Ladies Dancing Handbook6.jpg Nine Ladies Dancing Handbook5.jpg Nine Ladies Dancing Handbook4.jpg Find us on Facebook and Instagram where we will be posting the most up to date information. You can also find our private group page for more Nine Ladies Dancing Community information.

Fall Session you will be charged monthly on the 15th (Sept-April)

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Nine Ladies Dancing Handbook.jpg

Nine Ladies Dancing Handbook3.jpg

Fall Session you will be charged monthly on the 15th (Sept-April)

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Nine Ladies Dancing Handbook.jpg

Nine Ladies Dancing Handbook3.jpg

Fall Session you will be charged monthly on the 15th (Sept-April)

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Nine Ladies Dancing Handbook.jpg

Nine Ladies Dancing Handbook3.jpg

Fall Session you will be charged monthly on the 15th (Sept-April)

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Nine Ladies Dancing Handbook.jpg

Nine Ladies Dancing Handbook3.jpg

Fall Session you will be charged monthly on the 15th (Sept-April)

Enroll in Classes

Select Class

Add Another Student

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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?

Student #1

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