North Bay Performing Arts Association Contessi Ballet Online Registration

Registration

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Welcome to Contessi Ballet's online registration. To register you will need a credit or debit card and a valid email address. Charges will post after your registration has been reviewed and applicable discounts applied. You will be notified by email within 72 hours of the receipt and charges. If you have questions please contact contessiballet@comcast.net. You will receive a response within 72 hours; Contessi Ballet is an all-volunteer organization with the exception of our teachers.

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Referral Information

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Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type

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Home Phone

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Cell # *

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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*

Student Gender*

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)

Primary Doctor

Please click on the Search button below, then choose the class. https://app.jackrabbitclass.com/jr3.0/Openings/OpeningsJS?OrgID=535282

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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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please click on the Search button below, then choose the class. https://app.jackrabbitclass.com/jr3.0/Openings/OpeningsJS?OrgID=535282

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please click on the Search button below, then choose the class. https://app.jackrabbitclass.com/jr3.0/Openings/OpeningsJS?OrgID=535282

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please click on the Search button below, then choose the class. https://app.jackrabbitclass.com/jr3.0/Openings/OpeningsJS?OrgID=535282

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please click on the Search button below, then choose the class. https://app.jackrabbitclass.com/jr3.0/Openings/OpeningsJS?OrgID=535282

Enroll in Classes

Select Class *

Add Another Student

Required Policies

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Questions or Concerns

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Payment Information

Account Information

e-Payment Schedule*

Membership Type*

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?

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

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Student #3 (Show-Hide Details)

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