Creative Dance and Music Studio Online Registration

Registration

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Welcome to Creative Dance and Music Studio!

Please complete the following registration form to get started in dance or music lessons. If you have any questions about classes or schedules, please give us a call at 504-390-2552 or email at info@creativedanceandmusic.com. We are happy to help you get started today.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family/Account Name 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

Primary Contact First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

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 # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Years of Lessons*

Please click on the SELECT CLASS button below. It will display classes for your child's age.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Years of Lessons*

Please click on the SELECT CLASS button below. It will display classes for your child's age.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Years of Lessons*

Please click on the SELECT CLASS button below. It will display classes for your child's age.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Years of Lessons*

Please click on the SELECT CLASS button below. It will display classes for your child's age.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Creative Dance and Music Studio. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Years of Lessons*

Please click on the SELECT CLASS button below. It will display classes for your child's age.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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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

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)