Crosby Dance Academy Online Registration

Registration

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Welcome to Crosby Dance Academy! Please complete the following registration form. Registration requires a credit card and email address. Charges will be posted to your account after your registration has been reviewed and fees & discounts applied, if applicable. You will then be notified by email within 24-48 hours of the receipt and charges. If you have questions before registering, please contact the studio at 281-462-4778 or send an email to crosbydanceacademy@gmail.com

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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*

Additional Info

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

PROMO CODE

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Tshirt Size (youth/adult+size)*

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Tshirt Size (youth/adult+size)*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Tshirt Size (youth/adult+size)*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Tshirt Size (youth/adult+size)*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Tshirt Size (youth/adult+size)*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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)

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

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Credit Card

Required Policies

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