Step N' Time Online Registration

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Welcome to Step N' Time! Please complete the following registration form.

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Referral Information

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Account Information

Account Name 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

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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

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Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell #*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please be sure your child's date of birth is correct before proceeding. Please click on the Search button below, then choose the class. PLEASE be sure you've read the descriptions and age requirements/suggested limits from the website. If you have questions before registering, or during, please email me at stepntime2004@gmail.com CLASSES BEGIN SEPTEMBER 8th! THANK YOU! Miss Kimberly

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #*

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Credit Card

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Exp Month

Exp Year

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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 .

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Referral Information

Account 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

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Student #2 (Show-Hide Details)

Additional Info

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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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Questions or Concerns

Payment Information

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Credit Card

eCheck/Bank Draft

Required Policies

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