5678 Dance! Studio LLC Online Registration

Registration

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Welcome to 5678 Dance! Studio LLC! Please complete the following registration form. ALL SCHOOL YEAR CLASSES are divided by age and experience. Please note you must receive class time options directly from us before registering for a class. If you have not received which class times you can register for please email us at 5678danceoconomowoc@gmail.com FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

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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*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

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

Contact #2 First Name*

Last Name*

How can we contact you?

Home Phone *

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

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

Additional Info

T-Shirt Size

Grade Level*

Allergies (Leave blank if NONE)

STUDENTS ENROLLED IN THE 6 WEEK SUMMER SESSION PLEASE CHOOSE T-SHIRT SIZE ABOVE. (Choices: Child X-Small(2-4), Small(6-8), Medium(10-12), Large(14-16) and Adult Small, Medium, Large)

ALL SCHOOL YEAR CLASSES are divided by age and experience. Please note you must receive class time options directly from us before registering for a class. If you have not received which class times you can register for please email us at 5678danceoconomowoc@gmail.com

FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

T-Shirt Size

Grade Level*

Allergies (Leave blank if NONE)

STUDENTS ENROLLED IN THE 6 WEEK SUMMER SESSION PLEASE CHOOSE T-SHIRT SIZE ABOVE. (Choices: Child X-Small(2-4), Small(6-8), Medium(10-12), Large(14-16) and Adult Small, Medium, Large)

FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

T-Shirt Size

Grade Level*

Allergies (Leave blank if NONE)

STUDENTS ENROLLED IN THE 6 WEEK SUMMER SESSION PLEASE CHOOSE T-SHIRT SIZE ABOVE. (Choices: Child X-Small(2-4), Small(6-8), Medium(10-12), Large(14-16) and Adult Small, Medium, Large)

FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

T-Shirt Size

Grade Level*

Allergies (Leave blank if NONE)

STUDENTS ENROLLED IN THE 6 WEEK SUMMER SESSION PLEASE CHOOSE T-SHIRT SIZE ABOVE. (Choices: Child X-Small(2-4), Small(6-8), Medium(10-12), Large(14-16) and Adult Small, Medium, Large)

FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

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

Additional Info

T-Shirt Size

Grade Level*

Allergies (Leave blank if NONE)

STUDENTS ENROLLED IN THE 6 WEEK SUMMER SESSION PLEASE CHOOSE T-SHIRT SIZE ABOVE. (Choices: Child X-Small(2-4), Small(6-8), Medium(10-12), Large(14-16) and Adult Small, Medium, Large)

FALL/WINTER CAMPS & SUMMER SESSION will note age and you can sign up for them regardless of level.

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?

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)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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