Citrus Dance Online Registration

Registration

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Welcome to Citrus Dance! Please complete the following registration form to enrol in classes.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Name Last Name*

Where do you live?

Home Address*

City*

State*

Postcode*

Contact #1

Primary Contact First Name*

Last Name *

Relationship to Student*

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

Emergency Contact First Name*

Last Name*

Relationship to Student*

How can we contact you?

Home Phone

Work #

Cell # *

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School/Kinder Name*

School Year Level*

Allergies/Medical Conditions/Existing Injuries (Leave blank if NONE)

Year First Enrolled at Citrus*

To enrol in classes, please click the select class button below and choose from the listed classes.
If the class you would like to enrol in dose not appear in the list, please complete the registration form and email us at hello@citrusdance.com.au so we can add the class for you.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School/Kinder Name*

School Year Level*

Allergies/Medical Conditions/Existing Injuries (Leave blank if NONE)

Year First Enrolled at Citrus*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School/Kinder Name*

School Year Level*

Allergies/Medical Conditions/Existing Injuries (Leave blank if NONE)

Year First Enrolled at Citrus*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School/Kinder Name*

School Year Level*

Allergies/Medical Conditions/Existing Injuries (Leave blank if NONE)

Year First Enrolled at Citrus*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

School/Kinder Name*

School Year Level*

Allergies/Medical Conditions/Existing Injuries (Leave blank if NONE)

Year First Enrolled at Citrus*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

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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

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

Required Policies

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