Studio J Dance Academy Online Registration

Registration

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Welcome to Studio J Dance Academy Web Registration. Please complete the following registration form below and click submit when complete. Please note credit cards are NOT charged at this time. All enrollments are considered pending until we have reviewed your registration and posted any fees due. During this review process all discounts will be applied. If you have any questions contact us and we will be happy to assist you.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class. Don't see the class you want? Contact us at any time and we will try to add it to our schedule!

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class. Don't see the class you want? Contact us at any time and we will try to add it to our schedule!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class. Don't see the class you want? Contact us at any time and we will try to add it to our schedule!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class. Don't see the class you want? Contact us at any time and we will try to add it to our schedule!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Cell #

Additional Info

Student Email

T-Shirt Size

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Please click on the Search button below, then choose the class. Don't see the class you want? Contact us at any time and we will try to add it to our schedule!

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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)

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)