Trilogy Dance and Tumbling Center, LLC Online Registration

Registration

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Welcome to Trilogy! We are so excited to have you join our classes. Please note all fields must be filled out and Policies and Procedures must be signed. Tuition will be automatically charged to the card listed on your Parent Portal on the 25th of each month for the following months tuition. Please make sure to read our Procedures on our website www.trilogydtc.com under the NEWS tab as well as our Welcome Packet. Please contact us with any questions.

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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)*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Grade Level*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Student's may only enroll in the appropriate age and level of class.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Grade Level*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Student's may only enroll in the appropriate age and level of class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Grade Level*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Student's may only enroll in the appropriate age and level of class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Grade Level*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Student's may only enroll in the appropriate age and level of class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

Grade Level*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Student's may only enroll in the appropriate age and level of class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Membership Type*

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)

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

Account Information

Credit Card

Required Policies

(Show-Hide Details)