Dayton Performing Arts Alliance Online Registration

Registration

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Welcome to the music programs of the Dayton Performing Arts Alliance! Please complete the following registration form. Do not enter payment information if you are registering for Q the Music.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Parent/Guardian Contact #1 First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone

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 Contact #2 First Name

Last Name

Relationship

How can we contact you?

Home Phone

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level in 23-24 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies/Intolerances/Dietary Restrictions (Leave blank if NONE)

Medications (Leave blank if NONE)

Instrument*

Private Teacher, if applicable

Student pronouns

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level in 23-24 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies/Intolerances/Dietary Restrictions (Leave blank if NONE)

Medications (Leave blank if NONE)

Instrument*

Private Teacher, if applicable

Student pronouns

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level in 23-24 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies/Intolerances/Dietary Restrictions (Leave blank if NONE)

Medications (Leave blank if NONE)

Instrument*

Private Teacher, if applicable

Student pronouns

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level in 23-24 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies/Intolerances/Dietary Restrictions (Leave blank if NONE)

Medications (Leave blank if NONE)

Instrument*

Private Teacher, if applicable

Student pronouns

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level in 23-24 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies/Intolerances/Dietary Restrictions (Leave blank if NONE)

Medications (Leave blank if NONE)

Instrument*

Private Teacher, if applicable

Student pronouns

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

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

Registration

Family Information

Where do you live?

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

Required Policies

(Show-Hide Details)