Ziegfeld Arts Academy Online Registration

Registration

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Thank you for choosing to register for The Ziegfeld Arts Academy. We are excited to have you!

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Referral Information

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Referral Name

bethanyadmin

Family Last Name*

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Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

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

FACEBOOK COUPON CODE

FRIENDS AND FAMILY COUPON CODE

MY TECH HIGH FAMILY

DaVINCI FAMILY

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Work #

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Portal Access (your email is your login)

Email* (Emails are kept confidential)

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Portal Account Password

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Please select the classes you or your child wish to attend. There is a $25 registration fee for new families. Your card will be charged at the beginning of each month for classes that last more than one month or on the first day of class for those that don't. Please use our customer portal to be up to date on the Academy News, see payments, make payments and so on.

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Enroll in Classes

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Enroll in Classes

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

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Add Another Student

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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

bethanyadmin

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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