Broadway Babies and Kids Online Registration

Registration

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"I'm just a Broadway Baby, walking off my tired feet, pounding 42nd Street to be in a show!" ~Stephen Sondheim~ We are excited to have you start your Broadway performing arts journey with us, please take a moment to fill out the registration to get started!

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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?

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

How can we contact you?

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Immunizations YN

Immunizations Notes

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Immunizations YN

Immunizations Notes

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Immunizations YN

Immunizations Notes

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Immunizations YN

Immunizations Notes

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Broadway Babies and Kids. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Immunizations YN

Immunizations Notes

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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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)

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

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Student #4 (Show-Hide Details)

Additional Info

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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

eCheck/Bank Draft

Required Policies

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