Coomer Ballet Conservatory Online Registration

Registration

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Welcome to Coomer Ballet Conservatory! Use the Session Filter to ensure you sign up for the correct session. If a class if full, use the waitlist option. Email us at info@coomerballet.com or call us at 832-736-5838 for assistance.

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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 Name and Phone #<br/>(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone *

Work #

Cell # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Coomer Ballet Conservatory. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

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

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Allergies, Medications, Special Needs or Concerns for Instructor to Know (Leave blank if NONE)

Previous Dance studio (if any)

# of Years Dancing (if any)

Please click on the Search button below, then choose the classes. If a wanted class is full, please select waitlist to notify us of interest.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

Primary Method of Payment*

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

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Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

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