Dance With Me School of Dance Online Registration

Registration

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Welcome to Dance With Me School of Dance! Once your registration is submitted, we will review it, Charges will be automated to processed to the card on file. To pay in-full upfront for School Year classes for PIF discount, please email dancewithme@dwmsod.com

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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)

Would you like to pay in full?*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone

Work #

Cell # Receive Text Message Notifications

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*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

To pay in-full upfront for School Year classes, please email dancewithme@dwmsod.com

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

To pay in-full upfront for School Year classes, please email dancewithme@dwmsod.com

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

To pay in-full upfront for School Year classes, please email dancewithme@dwmsod.com

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

To pay in-full upfront for School Year classes, please email dancewithme@dwmsod.com

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications

Additional Info

Student Email

School

Grade Level

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

To pay in-full upfront for School Year classes, please email dancewithme@dwmsod.com

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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

Credit Card

Required Policies

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