american dance institute Online Registration

Registration

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Welcome! Please complete the form below to set up your customer portal. Free trials are not required to enter payment information. Full session registrations are required to enter payment information. E-checks are our preferred method of payment. You will not be automatically charged upon registration, but only after proper class selection is confirmed via email. Please sign up for text messaging to receive important updates about your class. Thank you!

* 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*

Additional Info

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

May we communicate via text*

Cell Phone Service Provider

Why did you choose our school?*

Coupon code? Enter here:

Have you seen our online ads?

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell # Receive Text Message Notifications

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)

List any Prior Training*

Injuries or limitations?*

Full Session Registration Students:

If paying by our monthly payment plan, please indicate that in the comments section of your registration form.

You are not charged upon registration, only after proper class selection is confirmed. E-check is our preferred payment method.

If you wish to pay with cash or check, please call the office and our wonderful staff will register you by phone.

Free Trial Class Students:

Payment information is optional at this time. Your card will not be charged until you decide to enroll for the session.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell # Receive Text Message Notifications

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)

List any Prior Training*

Injuries or limitations?*

Full Session Registration Students:

If paying by our monthly payment plan, please indicate that in the comments section of your registration form.

You are not charged upon registration, only after proper class selection is confirmed. E-check is our preferred payment method.

If you wish to pay with cash or check, please call the office and our wonderful staff will register you by phone.

Free Trial Class Students:

Payment information is optional at this time. Your card will not be charged until you decide to enroll for the session.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell # Receive Text Message Notifications

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)

List any Prior Training*

Injuries or limitations?*

Full Session Registration Students:

If paying by our monthly payment plan, please indicate that in the comments section of your registration form.

You are not charged upon registration, only after proper class selection is confirmed. E-check is our preferred payment method.

If you wish to pay with cash or check, please call the office and our wonderful staff will register you by phone.

Free Trial Class Students:

Payment information is optional at this time. Your card will not be charged until you decide to enroll for the session.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell # Receive Text Message Notifications

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)

List any Prior Training*

Injuries or limitations?*

Full Session Registration Students:

If paying by our monthly payment plan, please indicate that in the comments section of your registration form.

You are not charged upon registration, only after proper class selection is confirmed. E-check is our preferred payment method.

If you wish to pay with cash or check, please call the office and our wonderful staff will register you by phone.

Free Trial Class Students:

Payment information is optional at this time. Your card will not be charged until you decide to enroll for the session.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell # Receive Text Message Notifications

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)

List any Prior Training*

Injuries or limitations?*

Full Session Registration Students:

If paying by our monthly payment plan, please indicate that in the comments section of your registration form.

You are not charged upon registration, only after proper class selection is confirmed. E-check is our preferred payment method.

If you wish to pay with cash or check, please call the office and our wonderful staff will register you by phone.

Free Trial Class Students:

Payment information is optional at this time. Your card will not be charged until you decide to enroll for the session.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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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

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)