Juline School of Dance Online Registration

Registration

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Welcome to Juline School of Dance! Please complete the following registration form below. You will then be redirected to login to our Parent Portal to choose your classes at https://app.jackrabbitclass.com/jr3.0/ParentPortal/Login?orgID=536274. We are thrilled to know that you have chosen to dance with us.

* denotes required fields

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 # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Juline School of Dance. 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

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Juline School of Dance. 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 Sex*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Homeschool Funds Used Y/N*

School Dismissal Time*

Recital Y/N*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Sex*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Homeschool Funds Used Y/N*

School Dismissal Time*

Recital Y/N*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Sex*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Homeschool Funds Used Y/N*

School Dismissal Time*

Recital Y/N*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Sex*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Homeschool Funds Used Y/N*

School Dismissal Time*

Recital Y/N*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Sex*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Homeschool Funds Used Y/N*

School Dismissal Time*

Recital Y/N*

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

AutoPay Choice (for outstanding balances only)*

Would you like to support local arts with a recurring donation to Juline Foundation for Children?*

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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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

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)