Shining Star Dance Academy Online Registration

Registration

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Welcome to SSDA New Student online registration. Please complete the form below to register your child(ren) for SSDA classes. Tuition will be charged to your account after your registration has been reviewed. Tuition is due the 1st of every month. A $25 registration Fee per student will be charged to your account at registration. A multi-student discount is $35 per Rec student and $60 per Comp. The discount is applied to the smallest tuition. Question? Contact us at (989) 415-4394

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

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

Health Insurance Carrier*

Contact #1

Parent/Guardian #1 First Name*

Last Name *

Type*

How Can We Contact You?

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Parent/Guardian #2 First Name

Last Name

Type

How can we contact you?

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*

Disabilities (Leave blank if NONE)

Special Concerns (Leave blank if NONE)

Allergies*

Medications

Primary Doctor

Street Shoe Size (Ex: Girls 4)*

To register click search next to class listing. Choose which class you wish to register your child for. Continue this process until all classes are listed on the registration form. To add another child scroll down the page to student #2 section and complete the same process.

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*

Disabilities (Leave blank if NONE)

Special Concerns (Leave blank if NONE)

Allergies*

Medications

Primary Doctor

Street Shoe Size (Ex: Girls 4)*

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*

Disabilities (Leave blank if NONE)

Special Concerns (Leave blank if NONE)

Allergies*

Medications

Primary Doctor

Street Shoe Size (Ex: Girls 4)*

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*

Disabilities (Leave blank if NONE)

Special Concerns (Leave blank if NONE)

Allergies*

Medications

Primary Doctor

Street Shoe Size (Ex: Girls 4)*

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*

Disabilities (Leave blank if NONE)

Special Concerns (Leave blank if NONE)

Allergies*

Medications

Primary Doctor

Street Shoe Size (Ex: Girls 4)*

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

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

Required Policies

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