Durham School for Ballet & the Performing Arts Online Registration

Registration

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Welcome to Durham School for Ballet & the Performing Arts! We ask all families to complete this form and click "Submit Registration Information" at the bottom of the page.

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Referral Information

How did you hear about us?

Referral Name

Student Information

Students Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Discount Code

Contact #1

Responsible Party First Name*

Last Name *

Relationship to student*

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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Additional Contact [will receive email of enrollment information if email provided] First Name

Last Name

Relationship to student

How can we contact you?

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student's Identified Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Educational School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Preferred Pronouns

Date of most recent physical:

Please click on the Search button below, then choose a class.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Identified Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Educational School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Preferred Pronouns

Date of most recent physical:

Please click on the Search button below, then choose a class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Identified Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Educational School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Preferred Pronouns

Date of most recent physical:

Please click on the Search button below, then choose a class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Identified Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Educational School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Preferred Pronouns

Date of most recent physical:

Please click on the Search button below, then choose a class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Identified Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

Educational School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Preferred Pronouns

Date of most recent physical:

Please click on the Search button below, then choose a class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

Student Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

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

eCheck/Bank Draft

Required Policies

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