Melva Smith School of Dance Online Registration

Registration

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Welcome to Melva Smith School of Dance online registration; we're glad you're here! Students are required to have a debit / credit card or bank account information on file. Charges will be posted to your card or account after your registration has been reviewed and discounts applied, if applicable. Your annual membership fee will be auto-debited to hold your dancer's place in class. Thanks for joining our MSSoD family!

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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)*

Contact #1

Contact #1 First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone *

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

Relationship

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Special Needs to inform the teacher ie: allergies, asthma, inhaler etc

Allergies (Leave blank if NONE)

New or Returning Student*

Years With Melva Smith*

Choose any filter to begin viewing available classes

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*

Special Needs to inform the teacher ie: allergies, asthma, inhaler etc

Allergies (Leave blank if NONE)

New or Returning Student*

Years With Melva Smith*

Choose any filter to begin viewing available classes

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*

Special Needs to inform the teacher ie: allergies, asthma, inhaler etc

Allergies (Leave blank if NONE)

New or Returning Student*

Years With Melva Smith*

Choose any filter to begin viewing available classes

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*

Special Needs to inform the teacher ie: allergies, asthma, inhaler etc

Allergies (Leave blank if NONE)

New or Returning Student*

Years With Melva Smith*

Choose any filter to begin viewing available classes

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*

Special Needs to inform the teacher ie: allergies, asthma, inhaler etc

Allergies (Leave blank if NONE)

New or Returning Student*

Years With Melva Smith*

Choose any filter to begin viewing available classes

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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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)

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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)