Carolina Rosa Arts Academy Online Registration

Registration

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Welcome to Carolina Rosa Arts Academy! Please complete the following registration form.

* denotes required fields

Student Information

Student Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Contact #1

Parent or Guardian #1 First Name*

Last Name *

Relationship*

How Can We Contact You?

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

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

Relationship

How can we contact you?

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Carolina Rosa Arts Academy. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

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

Student 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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)