Komotion Dance Program Online Registration

Registration

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Welcome to Resurrection Movement Studio/ Komotion Dance Program! Please complete the following registration form. Completion of this form is required before you can enroll yourself or your child in class(es).

* denotes required fields

Referral Information

How did you hear about us?*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

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

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

T-Shirt Size*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Tshirt size*

Pronouns

Please click on the Search button below, then choose the class. Please note that classes are filled on a first-come, first-served basis. If the class of your choice is full, you can be added to the waitlist. We will contact you if openings become available.
Tuition payments are due by the 15th. of the month. After the 15th a $30.00 Late Fee will be added to your balance due. (Komotion Dance Program ONLY)

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Tshirt size*

Pronouns

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Tshirt size*

Pronouns

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Tshirt size*

Pronouns

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Tshirt size*

Pronouns

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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?

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

Required Policies

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