Registration

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Welcome to Impulse Dance Academy! Please complete the following registration form. This form registers you as a member of our studio and you will be unable to select classes yourself. We will contact you by phone or email to place your dancer in the class that best suits them. YOUR CREDIT CARD WILL NOT BE CHARGED UNTIL WE CALL OR EMAIL TO CONFIRM.

*   denotes required fields

Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Who is your employer?
Contact #2
How can we contact you?
(Emails are kept confidential)
Who is your employer?
Student #1
Additional Info
Required Policies
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Questions or Concerns
Payment Information
Account Information
Please fill out ONE of the following Payment Methods
Credit Card
eCheck/Bank Draft
(Your name on your bank statement)
(9-digit number)
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