Edgez Dance Online Registration

Registration

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Welcome to Edgez Dance! Please complete the following registration form to enroll your student in classes!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Account Information

(Please Enter the Student's Last Name for account purposes) Last Name*

Where do you live?

Home Address

City*

State*

Zip*

Primary Phone*

Contact #1

Primary Contact First Name*

Last Name *

Relationship to the Student/Dancer*

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

Contact #2

Secondary Contact First Name

Last Name

Relationship to the Student/Dancer

How can we contact you?

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities (Leave Blank if NONE)

Special Needs (Leave Blank if NONE)

Allergies (Leave Blank if NONE)

Medications (Leave Blank if NONE)

Primary Doctor

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

*If you are interested in doing a trial class, please contact the studio. The one-time drop-in fee for the trial is $20.00* *Please see our Facebook or Instagram for specials or discounts.

Have questions about our programs/ages? Visit our website: http://www.edgezdance.com

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities (Leave Blank if NONE)

Special Needs (Leave Blank if NONE)

Allergies (Leave Blank if NONE)

Medications (Leave Blank if NONE)

Primary Doctor

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

*If you are interested in doing a trial class, please contact the studio. The one-time drop-in fee for the trial is $20.00* *Please see our Facebook or Instagram for specials or discounts.

Have questions about our programs/ages? Visit our website: http://www.edgezdance.com

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities (Leave Blank if NONE)

Special Needs (Leave Blank if NONE)

Allergies (Leave Blank if NONE)

Medications (Leave Blank if NONE)

Primary Doctor

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

*If you are interested in doing a trial class, please contact the studio. The one-time drop-in fee for the trial is $20.00* *Please see our Facebook or Instagram for specials or discounts.

Have questions about our programs/ages? Visit our website: http://www.edgezdance.com

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities (Leave Blank if NONE)

Special Needs (Leave Blank if NONE)

Allergies (Leave Blank if NONE)

Medications (Leave Blank if NONE)

Primary Doctor

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

*If you are interested in doing a trial class, please contact the studio. The one-time drop-in fee for the trial is $20.00* *Please see our Facebook or Instagram for specials or discounts.

Have questions about our programs/ages? Visit our website: http://www.edgezdance.com

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities (Leave Blank if NONE)

Special Needs (Leave Blank if NONE)

Allergies (Leave Blank if NONE)

Medications (Leave Blank if NONE)

Primary Doctor

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

*If you are interested in doing a trial class, please contact the studio. The one-time drop-in fee for the trial is $20.00* *Please see our Facebook or Instagram for specials or discounts.

Have questions about our programs/ages? Visit our website: http://www.edgezdance.com

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

Tuition/Recital Collection 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

Account Information

Where do you live?

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

Account Information

Credit Card

Required Policies

(Show-Hide Details)