Lucky Penny Productions Napa Academy of Performing Arts Online Registration

Registration

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Hello! We are excited to offer performance arts courses through the Napa Academy of Performing Arts. We've made enrolling easy and convenient! Let's get started. Once you have completed the registration and class sign-up you will receive a confirmation email.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Additional Info

Emergency Contact Info<br/>(Not Contact #1 or #2) Provide Name and Mobile phone number*

Contact #1

Main Contact First Name*

Last Name *

Relationship*

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

Secondary Contact (optional) First Name

Last Name

Relationship

How can we contact you?

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below for a list of classes and enrollment opportunities.

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

School

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below for a list of classes and enrollment opportunities.

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

School

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below for a list of classes and enrollment opportunities.

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

School

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below for a list of classes and enrollment opportunities.

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

School

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below for a list of classes and enrollment opportunities.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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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*

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

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I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

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