Lanti Performing Arts Online Registration

Registration

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Welcome to Lanti Performing Arts! Please provide your information below and click "submit" when complete. NEW STUDENTS MUST COMPLETE THIS REGISTRATION FORM IN ORDER TO SET UP AN ACCOUNT IN OUR NEW SYSTEM. RETURNING FAMILIES PLEASE CLICK "ALREADY A CUSTOMER" ON TOP OF THIS PAGE. Your account will be reviewed and applicable tuition/fees will be processed within 1-3 business days. If you need any assistance, please contact us at office@lantiperformingarts.com or at 704-269-8420.

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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*

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*

Cell #

Additional Info

Student Email

School*

Grade Level

All School-Site Locations: Who is your classroom teacher?

Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Previous Musical/Acting Experience (leave blank if none)

Private Lesson Instrument #1

Private Lesson Instrument #2

Please click on the Search Button below, then choose your class(es).

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

School*

Grade Level

All School-Site Locations: Who is your classroom teacher?

Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Previous Musical/Acting Experience (leave blank if none)

Private Lesson Instrument #1

Private Lesson Instrument #2

Please click on the Search Button below, then choose your class(es).

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

School*

Grade Level

All School-Site Locations: Who is your classroom teacher?

Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Previous Musical/Acting Experience (leave blank if none)

Private Lesson Instrument #1

Private Lesson Instrument #2

Please click on the Search Button below, then choose your class(es).

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

School*

Grade Level

All School-Site Locations: Who is your classroom teacher?

Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Previous Musical/Acting Experience (leave blank if none)

Private Lesson Instrument #1

Private Lesson Instrument #2

Please click on the Search Button below, then choose your class(es).

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

School*

Grade Level

All School-Site Locations: Who is your classroom teacher?

Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Previous Musical/Acting Experience (leave blank if none)

Private Lesson Instrument #1

Private Lesson Instrument #2

Please click on the Search Button below, then choose your class(es).

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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

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

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)