Dance Concept, LLC Online Registration

Registration

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Registration is currently available for Virtual Class Series - May 2020 and Summer Camps and Intensives, & School Year 2020-2021. If you are interested in Virtual Private Lessons, please use this form: https://form.jotform.com/danceconcept/VirtualPrivates If you have questions, please contact our office. 817.738.8763 or danceconceptoffice@gmail.com

* 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*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone

Work #

Cell # *

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 #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email (if separate from parent)

School

Grade Level

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email (if separate from parent)

School

Grade Level

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email (if separate from parent)

School

Grade Level

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email (if separate from parent)

School

Grade Level

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email (if separate from parent)

School

Grade Level

Please click on the button below, then choose the class(es).

Enroll in Classes

Select Class

Add Another Student