KleinDance Arts Online Registration

Registration

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Welcome to KleinDance Arts! YOU CAN ENROLL AT ANYTIME 1) Please complete the following registration form. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS** 2) Please visit our website for all of our information at www.kleindancearts.com. 3) You can contact us by emailing kleindancearts@gmail.com OR call/text 805-268-2530. 4) Follow our Social Media on Facebook and Instagram @kleindancearts **STUDIO UPDATES ARE POSTED ON SOCIAL MEDIA & OUR STUDIO ENTRANCES.

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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 (Different from Contact #1 and #2) Phone Number Required*

Health Insurance Carrier

Alternate Pick-Up Person*

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 KleinDance Arts. 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 KleinDance Arts. 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 KleinDance Arts. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

YOU CAN ENROLL AT ANYTIME. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Please click on the 'Select Class' button below, then choose a class to enroll in.
Confirm your class selections before completing registration.
If you enroll in a class in error, please contact us for assistance.

Please become familiar with our protocols, policies, dress code, FAQs, and thoroughly read our online agreements.

**YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Enroll in Classes

Select Class

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 KleinDance Arts. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

YOU CAN ENROLL AT ANYTIME. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Please become familiar with our protocols, policies, dress code, FAQs, and thoroughly read our online agreements.

**YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Enroll in Classes

Select Class

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 KleinDance Arts. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

YOU CAN ENROLL AT ANYTIME. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Please become familiar with our protocols, policies, dress code, FAQs, and thoroughly read our online agreements.

**YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Enroll in Classes

Select Class

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 KleinDance Arts. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

YOU CAN ENROLL AT ANYTIME. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Please become familiar with our protocols, policies, dress code, FAQs, and thoroughly read our online agreements.

**YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Enroll in Classes

Select Class

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 KleinDance Arts. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

YOU CAN ENROLL AT ANYTIME. **YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Please become familiar with our protocols, policies, dress code, FAQs, and thoroughly read our online agreements.

**YOU WILL NOT BE CHARGED FOR A TRIAL CLASS**

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Method*

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

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

Account Information

Credit Card

Required Policies

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