Flex Performing Arts Online Registration

Registration

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Welcome to Flex Performing Arts! Please complete the following registration form. Your credit card information will be collected as part of the registration process but will not be charged. After you complete this form you will be directed to the parent portal where you can click the "Pay Now" button. Paying your balance due will complete the registration process and reserve your spot(s). If you have any questions at all please email us. Please do not enter general notes or questions.

* 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)*

Health Insurance Carrier

Authorized Adult for Pick Up

Contact #1

Contact #1 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

Contact #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*

Birth Date*

Cell #

Additional Info

Student Email

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

Pricing for classes:

1 class - $72.50/month

2 classes - $140/month

3 classes - $197.50/month

4 classes - $248/month

5 classes - $280.50/month

Any additional classes are $27.50/month per additional class

Please click on the Search button below, then choose your class(es) and/or camp(s).

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Pricing for classes:

1 class - $72.50/month

2 classes - $140/month

3 classes - $197.50/month

4 classes - $248/month

5 classes - $280.50/month

Any additional classes are $27.50/month per additional class

Please click on the Search button below, then choose your class(es) and/or camp(s).

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Pricing for classes:

1 class - $72.50/month

2 classes - $140/month

3 classes - $197.50/month

4 classes - $248/month

5 classes - $280.50/month

Any additional classes are $27.50/month per additional class

Please click on the Search button below, then choose your class(es) and/or camp(s).

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Pricing for classes:

1 class - $72.50/month

2 classes - $140/month

3 classes - $197.50/month

4 classes - $248/month

5 classes - $280.50/month

Any additional classes are $27.50/month per additional class

Please click on the Search button below, then choose your class(es) and/or camp(s).

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Pricing for classes:

1 class - $72.50/month

2 classes - $140/month

3 classes - $197.50/month

4 classes - $248/month

5 classes - $280.50/month

Any additional classes are $27.50/month per additional class

Please click on the Search button below, then choose your class(es) and/or camp(s).

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*

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

Credit Card

Required Policies

(Show-Hide Details)