Studio Dance Inc Online Registration

Registration

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2019-2020 Class schedule is posted and open for registration now! A $25 deposit must be paid in order to secure a spot in the class. This is non-refundable.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family 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?

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* (format=mm/dd/yyyy)

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Allergies*

Medications*

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

School*

Grade Level*

Disabilites*

Allergies*

Medications*

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

School*

Grade Level*

Disabilites*

Allergies*

Medications*

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

School*

Grade Level*

Disabilites*

Allergies*

Medications*

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

School*

Grade Level*

Disabilites*

Allergies*

Medications*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Responsibility Policy

I understand and acknowledge that participation in dance and tumbling can be hazardous and realize that no one should ever enter this activity unless they are in good medical condition. I assume all risk and will indemnify and hold harmless Studio Dance, Inc. for any injury or claim associated with this activity. I fully understand that it is my responsibility for the well being of my child/children when they are in the studio lobby, bathroom, or outside the studio.