Performing Arts Dance Centre Online Registration

Registration

Already a customer? Click here to login.

Welcome to Performing Arts Dance Centre! We've made enrolling your students easy and convenient. Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone

Additional Info

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

Emergency Contact Phone Number*

Who does student live with? *

Contact #1

Contact #1 First Name*

Last Name *

Relation 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

Contact #2 First Name

Last Name

Relation to Student

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

ADD or ADHD*

Any emotional concerns-anxiety, depression, shyness, ect.*

Cognative /Developmental Delays*

Allergies /Asthma/Breathing Issues*

Any Medications*

Heart Problems*

History of broken bones or major injuries*

Prior dance experience-Styles?

Previous dance school?

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

ADD or ADHD*

Any emotional concerns-anxiety, depression, shyness, ect.*

Cognative /Developmental Delays*

Allergies /Asthma/Breathing Issues*

Any Medications*

Heart Problems*

History of broken bones or major injuries*

Prior dance experience-Styles?

Previous dance school?

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

ADD or ADHD*

Any emotional concerns-anxiety, depression, shyness, ect.*

Cognative /Developmental Delays*

Allergies /Asthma/Breathing Issues*

Any Medications*

Heart Problems*

History of broken bones or major injuries*

Prior dance experience-Styles?

Previous dance school?

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

ADD or ADHD*

Any emotional concerns-anxiety, depression, shyness, ect.*

Cognative /Developmental Delays*

Allergies /Asthma/Breathing Issues*

Any Medications*

Heart Problems*

History of broken bones or major injuries*

Prior dance experience-Styles?

Previous dance school?

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

ADD or ADHD*

Any emotional concerns-anxiety, depression, shyness, ect.*

Cognative /Developmental Delays*

Allergies /Asthma/Breathing Issues*

Any Medications*

Heart Problems*

History of broken bones or major injuries*

Prior dance experience-Styles?

Previous dance school?

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
dance studios , gyms , swim schools , music schools , cheer gyms , childcare centers , and more .

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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)