Albemarle Ballet Theatre Online Registration

Registration

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Welcome to Albemarle Ballet Theatre! PLEASE NOTE: Upon completion of this form, you are enrolling for the school year or summer program and authorizing ABT to process your credit card on the 15th of each month. Your 1st tuition payment is due at the time of enrollment. After registration, log in to your Dancer Portal and make your first payment. This first payment serves as a deposit, without which we cannot guarantee a spot in the class.

* 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)

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

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*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Disabilities

Special Needs

Allergies

Medications

Immunization Notes

NEW STUDENTS: Please email us about level placement before enrolling. All new students with prior dance experience will take a placement class. *Class Descriptions can be found on our website.

If you decide not to continue after the first class, please email Jenn@abtdance.org right away and we will refund any applicable payments made on your account. Students will be considered enrolled and billed as such unless told otherwise.

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

T-Shirt Size

School

Grade Level

Disabilities

Special Needs

Allergies

Medications

Immunization Notes

NEW STUDENTS: Please email us about level placement before enrolling. All new students with prior dance experience will take a placement class. *Class Descriptions can be found on our website.

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

T-Shirt Size

School

Grade Level

Disabilities

Special Needs

Allergies

Medications

Immunization Notes

NEW STUDENTS: Please email us about level placement before enrolling. All new students with prior dance experience will take a placement class. *Class Descriptions can be found on our website.

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

T-Shirt Size

School

Grade Level

Disabilities

Special Needs

Allergies

Medications

Immunization Notes

NEW STUDENTS: Please email us about level placement before enrolling. All new students with prior dance experience will take a placement class. *Class Descriptions can be found on our website.

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

T-Shirt Size

School

Grade Level

Disabilities

Special Needs

Allergies

Medications

Immunization Notes

NEW STUDENTS: Please email us about level placement before enrolling. All new students with prior dance experience will take a placement class. *Class Descriptions can be found on our website.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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

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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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)