LivingArtsDance, Inc. Online Registration

Registration

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Welcome to LivingArtsDance, Inc. 2023, 18th Season Registration! Youth class spaces will not be saved without a $55.00 registration fee paid at the time of completing this registration form. You must use a debit or credit card to register online. ALL PAYMENTS ARE NONREFUNDABLE. Please call 888.257.9991 if you have any questions or concerns. Thank you.

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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)*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Optional Contact #2 First Name

Last Name

Type

How can we contact you?

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities

Special Needs or Behavioral Heath Diagnosis

Allergies

Medications (Leave blank if NONE)

Use of photo allowed?*

Student May Be Released To?*

Public Transportation Allowed?*

Permission to give Medication*

Student sign themself In/Out?*

PLEASE CLICK ON THE SEARCH BUTTON BELOW, THEN CHOOSE YOUR CHILD'S CLASSES. IF YOU ARE HAVING TROUBLE PLEASE CALL THE STUDIO 888.257.9991 AND WE CAN PLACE YOUR CHILD IN A CLASS.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities

Special Needs or Behavioral Heath Diagnosis

Allergies

Medications (Leave blank if NONE)

Use of photo allowed?*

Student May Be Released To?*

Public Transportation Allowed?*

Permission to give Medication*

Student sign themself In/Out?*

PLEASE CLICK ON THE SEARCH BUTTON BELOW, THEN CHOOSE YOUR CHILD'S CLASSES. IF YOU ARE HAVING TROUBLE PLEASE CALL THE STUDIO 888.257.9991 AND WE CAN PLACE YOUR CHILD IN A CLASS.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities

Special Needs or Behavioral Heath Diagnosis

Allergies

Medications (Leave blank if NONE)

Use of photo allowed?*

Student May Be Released To?*

Public Transportation Allowed?*

Permission to give Medication*

Student sign themself In/Out?*

PLEASE CLICK ON THE SEARCH BUTTON BELOW, THEN CHOOSE YOUR CHILD'S CLASSES. IF YOU ARE HAVING TROUBLE PLEASE CALL THE STUDIO 888.257.9991 AND WE CAN PLACE YOUR CHILD IN A CLASS.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities

Special Needs or Behavioral Heath Diagnosis

Allergies

Medications (Leave blank if NONE)

Use of photo allowed?*

Student May Be Released To?*

Public Transportation Allowed?*

Permission to give Medication*

Student sign themself In/Out?*

PLEASE CLICK ON THE SEARCH BUTTON BELOW, THEN CHOOSE YOUR CHILD'S CLASSES. IF YOU ARE HAVING TROUBLE PLEASE CALL THE STUDIO 888.257.9991 AND WE CAN PLACE YOUR CHILD IN A CLASS.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

Grade Level*

Disabilities

Special Needs or Behavioral Heath Diagnosis

Allergies

Medications (Leave blank if NONE)

Use of photo allowed?*

Student May Be Released To?*

Public Transportation Allowed?*

Permission to give Medication*

Student sign themself In/Out?*

PLEASE CLICK ON THE SEARCH BUTTON BELOW, THEN CHOOSE YOUR CHILD'S CLASSES. IF YOU ARE HAVING TROUBLE PLEASE CALL THE STUDIO 888.257.9991 AND WE CAN PLACE YOUR CHILD IN A CLASS.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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)

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

Credit Card

Required Policies

(Show-Hide Details)