Hello Dancer Online Registration

Registration

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Welcome to Hello Dancer! Please complete this registration form for your access into the magical world for creative arts for your children! Make sure you check the proper location (Austin or Lafayette) for your classes, party or camp!

* 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*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Health Insurance Carrier

ENTER DISC CODE:

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

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Special Needs: (Explain or NO)*

Allergies: (Explain or NO)*

Medications (Leave blank if NONE)

Primary Doctor

Discount Code

Please click on the Search button below, then choose the Class, Birthday Party Registration, Camp, or Event

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Special Needs: (Explain or NO)*

Allergies: (Explain or NO)*

Medications (Leave blank if NONE)

Primary Doctor

Discount Code

Please click on the Search button below, then choose the Class, Birthday Party Registration, Camp, or Event

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Special Needs: (Explain or NO)*

Allergies: (Explain or NO)*

Medications (Leave blank if NONE)

Primary Doctor

Discount Code

Please click on the Search button below, then choose the Class, Birthday Party Registration, Camp, or Event

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Special Needs: (Explain or NO)*

Allergies: (Explain or NO)*

Medications (Leave blank if NONE)

Primary Doctor

Discount Code

Please click on the Search button below, then choose the Class, Birthday Party Registration, Camp, or Event

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Special Needs: (Explain or NO)*

Allergies: (Explain or NO)*

Medications (Leave blank if NONE)

Primary Doctor

Discount Code

Please click on the Search button below, then choose the Class, Birthday Party Registration, Camp, or Event

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios , gyms , swim schools , music schools , cheer gyms , childcare centers , and more .

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

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)