Alton Street Dance, LLC Online Registration

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Welcome to Alton Street Dance, LLC! We are thrilled that you are here. Please complete the following registration form.

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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 Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities *

Special Needs *

Allergies *

Medications (Leave blank if NONE)

Photo Release Y/N*

Please note that tuition will be posted and charged to your account the 1st of each month. Tuition is due September through May.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities *

Special Needs *

Allergies *

Medications (Leave blank if NONE)

Photo Release Y/N*

Please note that tuition will be posted and charged to your account the 1st of each month. Tuition is due September through May.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities *

Special Needs *

Allergies *

Medications (Leave blank if NONE)

Photo Release Y/N*

Please note that tuition will be posted and charged to your account the 1st of each month. Tuition is due September through May.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities *

Special Needs *

Allergies *

Medications (Leave blank if NONE)

Photo Release Y/N*

Please note that tuition will be posted and charged to your account the 1st of each month. Tuition is due September through May.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Grade Level*

Disabilities *

Special Needs *

Allergies *

Medications (Leave blank if NONE)

Photo Release Y/N*

Please note that tuition will be posted and charged to your account the 1st of each month. Tuition is due September through May.

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*

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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)

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

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