Illusion Dance Center Online Registration

Registration

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Welcome to Illusion Dance Center! At this time, registration is closed for all recital performing classes. You may still trial and enroll in the following classes, pending space availability: Junior and Intermediate Acro (Advance Acro must have instructor approval); Intermediate and Advanced Technique; and Drill Team Prep.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Account Holder 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

Parent/Guardian #1 (Primary Contact) First Name*

Last Name *

Type*

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

Parent/Guardian #2 First Name

Last Name

Type

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*

Additional Info

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)*

Primary Doctor

Please click on the Search button below, "filter" for 2021-2022, then choose the class.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

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)*

Primary Doctor

Please click on the Search button below, "filter" for 2021-2022, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

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)*

Primary Doctor

Please click on the Search button below, "filter" for 2021-2022, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

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)*

Primary Doctor

Please click on the Search button below, "filter" for 2021-2022, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

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)*

Primary Doctor

Please click on the Search button below, "filter" for 2021-2022, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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
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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

Account Information

Credit Card

Required Policies

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