Bailey Fine Arts Online Registration

Registration

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Welcome to Bailey Fine Arts! Please provide your information below and click Submit when complete. All enrollments are considered pending until we have reviewed your registration, posted charges, and billed all fees due on the credit card that you provide with this form.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Account Last Name 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 *

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

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 #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor*

If you are new to BFA, please call or email the studio for guidance on the most appropriate level classes. We may suggest a placement class for your child, prior to enrolling online.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor*

If you are new to BFA, please call or email the studio for guidance on the most appropriate level classes. We may suggest a placement class for your child, prior to enrolling online.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor*

If you are new to BFA, please call or email the studio for guidance on the most appropriate level classes. We may suggest a placement class for your child, prior to enrolling online.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor*

If you are new to BFA, please call or email the studio for guidance on the most appropriate level classes. We may suggest a placement class for your child, prior to enrolling online.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Primary Doctor*

If you are new to BFA, please call or email the studio for guidance on the most appropriate level classes. We may suggest a placement class for your child, prior to enrolling online.

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?

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

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)