THE ROLLE PROJECT Online Registration

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Welcome to Studio 305! Home of the Rolle Project. We are excited to have you join our family. Please complete the following registration form below. If you have any questions after completing the forms call 702-444-0773 to finalize your account. We offer classes for ages 3-15yrs and also opportunities for 16 & Up. Summer Intensive Camp May 21-June 28,2024 8-4pm & July 22-Aug 1,2024 Evening classes June 1-28,2024 Tuesday, Thursday 5-7pm & Sat 10-12pm

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Referral Information

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Referral Name

Family Information

Family Last Name*

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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*

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Home Phone

Work #

Cell # *

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Email* (Emails are kept confidential)

Confirm Email*

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Confirm Portal Account Password

Who is your employer?

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Employer Phone

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Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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)

Medications (Leave blank if NONE)

Immunization Notes

Dress Code Studio 305 Black Leotard, Flesh tone or Pink Tights for Ballet and & soft Pink or Flesh tone ballet shoes are needed for class. You can purchase your Studio T-shirt, shorts and unitard in the office. Each level has a dress code.

Please Enter through the back door and exit out of the front!

All dancers must sign in the lobby area before entering into class.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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)

Medications (Leave blank if NONE)

Immunization Notes

Please Enter through the back door and exit out of the front!

All dancers must sign in the lobby area before entering into class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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)

Medications (Leave blank if NONE)

Immunization Notes

Please Enter through the back door and exit out of the front!

All dancers must sign in the lobby area before entering into class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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)

Medications (Leave blank if NONE)

Immunization Notes

Please Enter through the back door and exit out of the front!

All dancers must sign in the lobby area before entering into class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

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)

Medications (Leave blank if NONE)

Immunization Notes

Please Enter through the back door and exit out of the front!

All dancers must sign in the lobby area before entering into class.

Enroll in Classes

Select Class

Add Another Student

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Questions or Concerns

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e-Payment Schedule*

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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

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

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Who is your employer?

Contact #2

How can we contact you?

Student #1

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