Tippy Toes School of Dance Online Registration

Registration

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Welcome to Tippy Toes School of Dance! ALL STUDENTS, CURRENT AND NEW, MUST CREATE AN ACCOUNT. Registration is FREE and you can take your first class under no obligation (tuition for your first class will only be charged if you decide to continue). Please complete the following registration form in order to get started. If you have any questions, please feel free to contact Ben Manship @ 317-709-8077. Thank you, and we hope to see you real soon!

* denotes required fields

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)

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Cell # *

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*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the "select class" button below, then choose the class that you would like to join.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the "select class" button below, then choose the class that you would like to join.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the "select class" button below, then choose the class that you would like to join.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the "select class" button below, then choose the class that you would like to join.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Please click on the "select class" button below, then choose the class that you would like to join.

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*

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Registration

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

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)